Perspective Chapter: Transcatheter Aortic Valve Implantation (TAVI)-Anesthetic Considerations

Aortic valvular stenosis remains the most common weakening valvular heart lesion. Many high-risk patients cannot tolerate surgery. Transcatheter aortic valve implantation (TAVI) is an emergent alternative technique. General and local anesthesia plus sedation are both valid alternative techniques that can be titrated according to patient characteristics. Hemodynamic management is the main concern of intraoperative anesthesiological management. Preprocedural, multidisciplinary assessment of the patient is essential prior to TAVI and should include a full anesthetic evaluation. TAVI offers a number of advantages to patients and medical teams, but there are still accompanying important complications and anesthesiological risks

Perspective Chapter: Moderate Aortic Stenosis and Heart Failure With Reduced Ejection Fraction; Early Replacement or Conservative Treatment?

Aortic stenosis (AS) is the most common valve lesion among the continuously aging population with serious effect on the left ventricular ejection fraction (LVEF). If left untreated, it is associated with serious complications such as heart failure (HF), pulmonary hypertension, thromboembolic events, and even sudden death. Early diagnosis and treatment is of outmost importance to avoid the above complications but also to maintain the patient’s normal heart function. Echocardiography is the key examination that assesses the severity of the stenosis, valve calcification, left ventricular (LV) function, and wall thickness. Also new imaging methods such as cardiac computed tomography (CT) and cardiac magnetic resonance imaging (MRI) help in assessing the severity of aortic valve stenosis when echocardiography has limitations. Based on the categorization of the severity of the stenosis, its treatment is determined. Although things are clear in cases of asymptomatic disease and severe stenosis, this is not the case in moderate disease. Experts and clinical trials do not define clearly which cases can be treated conservatively and which need surgical or transcatheter intervention. The purpose of this article is to gather all the latest data on the treatment of moderate aortic stenosis, especially in patients with heart failure and low ejection fraction