Evolución del manejo anestésico y perioperatorio en el implante transcatéter de la Válvula Aórtica en un Centro Cardiovascular Colombiano: experiencia de la Fundación Cardioinfantil

Abstract

Background: Transcatheter Aortic Valve Implantation (TAVI) is an alternative for the management of aortic stenosis and has undergone rapid perioperative management evolution. International centers have reported that as the experience evolves, the results improve. The aim is to describe the evolution of the anesthetic and perioperative management of TAVI at the Fundación Cardioinfantil between January 2014 and June 2020. Methods: Observational, retrospective descriptive study. Evolution of preoperative, intraoperative and postoperative variables will be described. Results: 206 procedures were performed. Over time, a change in patients with high surgical to intermediate risk was found. At the beginning the procedures were performed in the operation room, then an hybrid room was implemented. Initially all were performed under general anesthesia and later 90% under sedation. Use of central venous catheter (77%) or a pulmonary artery catheter (23%) was changed to 89% only with an arterial catheter. Use of transesophageal echocardiography changed from 100% to 0%. There was a decrease in the duration of the procedure from 175 minutes to 56 minutes. In the postoperative, decrease in hospitalization from 7 to 3 days was observed. The complications that showed a decrease were: mechanical ventilation (31% to 0%), atrial fibrillation (8% to 0%), need for a pacemaker (8% to 0%), major vascular complications (38% to 0%) and 30-day mortality (46% to 4%). Conclusions: The evolution in perioperative management for TAVI in our center was characterized by the selection of lower risk patients, implementation of the hybrid room, change from general anesthesia to sedation, less invasive intraoperative monitoring, reduction of procedure and hospitalization time, less complications and decreased in 30-day mortality.