Shaping the Anesthetic Approach to TricValve Implantation: Insights From a Case Series.
J Cardiothorac Vasc Anesth
; 38(4): 911-917, 2024 Apr.
Article
in En
| MEDLINE
| ID: mdl-38281824
ABSTRACT
OBJECTIVES:
Caval valve implantation (CAVI) represents a minimally invasive strategy for managing severe tricuspid regurgitation in high-risk patients unsuitable for surgical or transcatheter tricuspid valve implantation. This case series aimed to assess the anesthesia management challenges and outcomes associated with this procedure, seeking to generate insights that can inform and refine anesthesia protocols.DESIGN:
A case series.SETTING:
At a cardiac catheterization laboratory of a teaching hospital.PARTICIPANTS:
Eight patients undergoing CAVI with the Tricvalve systemINTERVENTIONS:
The anesthetic protocol included preprocedural planning, fast-track general anesthesia, and postprocedural debriefing. Intraoperative management involved anesthesia depth monitoring, real-time guidance via transesophageal echocardiography, and hemodynamic stability maintenance. Postoperative analgesia involved preemptive intravenous paracetamol and morphine as needed. MEASUREMENTS AND MAINRESULTS:
No anesthesia-related or implantation-related complications were observed, with a mean procedure duration of 112 ± 44 minutes. The median hospital stay was 4 days, and only 1 patient required brief intensive care unit monitoring. Postoperative right shoulder pain was reported by half of the patients, and was managed with morphine bolus administration (average dose 4.75 ± 3.6 mg). All patients had the device correctly positioned, as confirmed by postoperative transthoracic echocardiograms. None of the patients required outpatient analgesic therapy upon discharge.CONCLUSIONS:
The authors' study demonstrated the potential of TricValve implantation in effectively managing severe tricuspid regurgitation with no procedure-related complications and a 100% survival rate. A collaborative, interdisciplinary approach and targeted anesthesia management proved crucial for this success. Postoperative shoulder pain emerged as a frequent complication, whose pathogenesis is still not clear, and successfully was managed using targeted analgesic therapy.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Tricuspid Valve Insufficiency
/
Heart Valve Prosthesis Implantation
/
Anesthetics
Type of study:
Guideline
Limits:
Humans
Language:
En
Journal:
J Cardiothorac Vasc Anesth
Journal subject:
ANESTESIOLOGIA
/
CARDIOLOGIA
Year:
2024
Document type:
Article
Affiliation country:
Italia
Country of publication:
Estados Unidos