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Measurement of stroke volume with echocardiography compared to gold standard cardiac magnetic resonance imaging An observational study
The assessment of Doppler-derived left ventricular outflow tract (LVOT) stroke volume (SV) is fundamental in outpatient, perioperative and critical care echocardiography.1 Calculation of SV allows assessment of the severity of aortic stenosis (AS) and evaluation of the haemodynamic state during undifferentiated hypotension.2 The use of focused transthoracic echocardiography (TTE) has appeal in a critical care environment, where after a single measurement of the LVOT area, pulsed wave Doppler velocity time integral (VTI) in the LVOT is used to calculate LVOT SV.
Source: Journal of Cardiothoracic and Vascular Anesthesia - May 16, 2023 Category: Anesthesiology Authors: Brian Cowie, Leah Wright, Ben Costello, Kristel Janssens, Erin Howden, Darragh Flannery, Steve Foulkes, Roman Kluger, Andre La Gerche Tags: Original Article Source Type: research

Laparoscopic adrenalectomy of pheochromocytoma following management of severe aortic stenosis with transcatheter aortic valve replacement under monitored anesthesia care sedation: a case report
Management of a patient with an active pheochromocytoma and severe aortic stenosis remains controversial. Adrenalectomy for a pheochromocytoma poses a high risk for stroke, hypertensive emergency, and mortalit...
Source: BMC Anesthesiology - January 11, 2023 Category: Anesthesiology Authors: Leon Yang, Lauren Hennis, Kevin Patel and Michael A. Saccocci Tags: Case report Source Type: research

Self-Expanding Versus Balloon-Expandable Valve: Are We at the Cusp of Delivering a Perfect Transcatheter Aortic Valve?
Transcatheter aortic valve replacement (TAVR) has become a leading and dominant treatment alternative to surgical aortic valve replacement (SAVR) for intermediate- and high-risk patients with aortic stenosis.1-5 The follow-up trials for both the core valve, as well as the balloon-expanding valve, showed similar midterm survival and stroke rates in high-risk patients following TAVR versus SAVR.6-8 With the recent results of the PARTNER 3 and EVOLUT low-risk trials, it is evident that, among patients with severe aortic stenosis with low surgical risks, the rates of composite death, stroke, and rehospitalization at 1 year wer...
Source: Journal of Cardiothoracic and Vascular Anesthesia - November 26, 2021 Category: Anesthesiology Authors: Ankit Jain Tags: Editorial Source Type: research

Self-Expanding versus Balloon Expandable Valve – Are we at the Cusp of Delivering a Perfect Transcatheter Aortic Valve?
Transcatheter aortic valve replacement (TAVR) has become a leading and dominant treatment alternative to surgical aortic valve replacement (SAVR) for high- and intermediate-risk patients with aortic stenosis.1 –5 The follow up trials for both the core valve as well as the balloon-expanding valve showed similar mid-term survival and stroke rates in high-risk patients following TAVR vs SAVR.6–8 With the recent results of the PARTNER 3 and EVOLUT low risk trials, it is evident that, among patients with s evere aortic stenosis with low surgical risks, the rate of composite death, stroke and rehospitalization at 1 year was ...
Source: Journal of Cardiothoracic and Vascular Anesthesia - November 26, 2021 Category: Anesthesiology Authors: Ankit Jain Tags: Editorial Source Type: research

Assessment of the left ventricular outflow tract during cardiac anaesthesia with biplane transoesophageal echocardiography: An observational study
BACKGROUND Assessment of left ventricular outflow tract (LVOT) area is a key component of quantification of aortic stenosis and stroke volume. Current international guidelines recommend measurement of the LVOT diameter with two-dimensional (2D) echocardiography and assume a circle. This may lead to erroneous measures of aortic valve area and adversely affect peri-operative decision making. Multiplane orthogonal (biplane) and three-dimensional (3D) echocardiography imaging may allow more accurate calculation of LVOT, aortic valve area and stroke volume. OBJECTIVE To evaluate the shape and area of the LVOT with co...
Source: European Journal of Anaesthesiology - November 19, 2021 Category: Anesthesiology Tags: Haemodynamics Source Type: research

The PARTNER 3 Trial at Two Years: What We Have Learned and What Time Will Tell
Based on data from large, industry-sponsored randomized prospective studies, the US Food and Drug Administration (FDA) has approved both balloon-expandable and self-expanding transcatheter aortic valve replacement (TAVR) devices for use in aortic stenosis patients at low, intermediate, and high risk for surgical aortic valve replacement (SAVR).1-6 High-risk device approval was based on one-year data, which was reasonable due to the actuarial life expectancies of the cohort.1,2 Intermediate-risk approval for the balloon-expandable SAPIEN XT (Edwards Lifesciences, Irvine, CA) system was based largely on data from the Placeme...
Source: Journal of Cardiothoracic and Vascular Anesthesia - May 28, 2021 Category: Anesthesiology Authors: Peter J. Neuburger, Kinjal M. Patel, Prakash A. Patel Tags: Editorial Source Type: research

The PARTNER 3 Trial at 2 Years: What We've Learned and What Time Will Tell
Based on data from large, industry-sponsored randomized prospective studies, the United States Food and Drug Administration (FDA) has approved both balloon-expandable and self-expanding transcatheter aortic valve replacement (TAVR) devices for use in aortic stenosis patients at low, intermediate and high-risk for surgical aortic valve replacement (SAVR).1-6 High-risk device approval was based on 1-year data, which was reasonable due to the actuarial life expectancies of the cohort.1, 2 Intermediate-risk approval for the balloon-expandable Sapien XT (Edwards Lifesciences, Irvine, California) system was largely based on data...
Source: Journal of Cardiothoracic and Vascular Anesthesia - May 28, 2021 Category: Anesthesiology Authors: Peter J. Neuburger, Kinjal M. Patel, Prakash A. Patel Source Type: research

A Case of Successful Treatment of Cerebral Embolism Using Endovascular Thrombectomy Immediately After Transcatheter Aortic Valve Implantation
TRANSCATHETER aortic valve implantation (TAVI) is a less invasive alternative to surgical aortic valve replacement in high-risk patients with severe aortic stenosis. However, there are increasing concerns about the potential complications of TAVI now that its indications have been expanded to include patients with low-to-intermediate surgical risk.1,2 One of the serious complications of TAVI is stroke. It is known that there is an increase in 30-day mortality, rates of respiratory insufficiency and postprocedural delirium, and duration of hospital stay if stroke occurs.
Source: Journal of Cardiothoracic and Vascular Anesthesia - December 17, 2019 Category: Anesthesiology Authors: Shunichi Murakami, Kazuyoshi Ishida, Hideyuki Ishihara, Takayuki Okamura, Tetsuro Oda, Ryo Suzuki, Atsuo Yamashita, Satoshi Yamashita, Hiroshi Kurazumi, Michiyasu Suzuki, Mishiya Matsumoto Tags: Case Report Source Type: research

Percutaneous Coronary Artery Revascularization and Transcatheter Aortic Valve Replacement: Is There a Who, Why, and When?
WITH A PREVALENCE in aortic stenosis (AS) patients of 25% to 50%, concomitant coronary artery disease (CAD) has proven to be an independent risk factor for patients undergoing transcatheter aortic valve replacement (TAVR).1 Currently there is no standard- or guideline-driven approach for these patients, and many new challenges have emerged in this population. In this issue of the Journal of Cardiothoracic and Vascular Anesthesia, Bacigalupo et al.2 report a case of a patient with recent percutaneous coronary intervention (PCI) for obstructive CAD who underwent TAVR complicated by in-stent thrombosis and an ischemic stroke ...
Source: Journal of Cardiothoracic and Vascular Anesthesia - February 20, 2019 Category: Anesthesiology Authors: Oscar D. Aljure, Michael Fabbro Tags: Editorial Source Type: research

Analysis of Neurologic Complications After Surgical Versus Transcatheter Aortic Valve Replacement
Ove the last decade, transcatheter aortic valve replacement (TAVR) has emerged as the recommended approach over surgical aortic valve replacement (SAVR) for many patients with aortic stenosis. While initial trials demonstrated a higher incidence of stroke with TAVR compared to SAVR, the incidence of stroke appears to have improved over time. With the increasing number of patients expected to undergo TAVR in the coming decades, it is important to review the incidence and etiology of stroke after SAVR and TAVR.
Source: Journal of Cardiothoracic and Vascular Anesthesia - December 27, 2018 Category: Anesthesiology Authors: Sundar Krishnan, Archit Sharma, Sudhakar Subramani, Lovkesh Arora, Divyanshu Mohananey, Pedro Villablanca, Harish Ramakrishna Tags: Expert Review Source Type: research

Perioperative Management of Pheochromocytoma Resection in a Patient With Severe Aortic Stenosis
PHEOCHROMOCYTOMA IS A rare catecholamine-secreting tumor composed of chromaffin tissue arising from the adrenal medulla. Surgical resection is a high-risk procedure and remains a clinical challenge for anesthesiologists and surgeons. There is potential for massive and sudden changes in catecholamine release resulting in significant hemodynamic effects, which in turn can lead to devastating cardiac and neurologic complications such as myocardial infarction, stroke, or death. Advances in medical management and anesthetic and surgical techniques have led to improved surgical outcomes.
Source: Journal of Cardiothoracic and Vascular Anesthesia - December 21, 2017 Category: Anesthesiology Authors: Jagroop Singh Saran, Jacob Moalem, Luke Schoeniger, Konstantine Tzimas Tags: Case Report Source Type: research

Transcatheter Aortic Valve Replacement After Intraoperative Discovery of Porcelain Aorta in a Patient With Aortic Stenosis
PORCELAIN AORTA IS a major risk factor for stroke after cardiac surgery and may prompt alterations in surgical technique.1,2 Transcatheter aortic valve replacement (TAVR) has become a preferred treatment for patients with aortic stenosis and porcelain aorta.2 –4 Although TAVR has become a common procedure worldwide, this procedure typically is characterized by extensive preprocedural planning by a multidisciplinary heart team.5–9 This case conference describes a scenario in which TAVR was performed successfully on an urgent basis after intraoperative discovery of a porcelain aorta in a patient with severe aortic stenos...
Source: Journal of Cardiothoracic and Vascular Anesthesia - August 17, 2016 Category: Anesthesiology Authors: Rohesh Fernando, Jacob T. Gutsche, John G.T. Augoustides, Jeremy D. Kukafka, Warren Spitz, Jonathan Frogel, Michael Fabbro, Prakash A. Patel Tags: Case ConferenceVictor C. Baum, MDSection Editors? > Source Type: research

Dynamic variables and fluid responsiveness in patients for aortic stenosis surgery
ConclusionsThe arterial pressure‐based variables had moderate predictive values before valve replacement, but it predicted fluid responsiveness well postoperatively. Pleth variability index did not predict fluid responsiveness preoperatively, and it had a moderate predictive value postoperatively. These results indicate that arterial pressure‐based dynamic variables have limited potential to guide fluid therapy in patients with aortic stenosis. Their ability to guide fluid therapy after aortic valve replacement seems better.
Source: Acta Anaesthesiologica Scandinavica - April 29, 2014 Category: Anesthesiology Authors: L. Ø. HØISETH, I. E. HOFF, O. A. HAGEN, S. A. LANDSVERK, K. A. KIRKEBØEN Tags: Original Article Source Type: research

AANA Journal Course: Update for nurse aneshtetists--part-4--transcatheter aortic valve replacement.
Abstract Aortic stenosis is the most frequently acquired heart disease, and the prevalence is rising because of the aging population. If the disease is left untreated, survival in symptomatic patients averages only 2 to 3 years. Surgical aortic valve replacement is the only definitive treatment, yet 30% of elderly patients are not considered candidates because the presence of comorbidities makes the risk of sternotomy and cardiopulmonary bypass prohibitively high. Transcatheter aortic valve replacement (TAVR) is an innovative, high-tech, less invasive alternative. The procedure is usually performed using general a...
Source: AANA Journal - October 1, 2013 Category: Anesthesiology Authors: Contrera P, Cushing M Tags: AANA J Source Type: research

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