To the Editor:
In the February 2017 article entitled “The Anesthesia Professional’s Role in Patient Safety During TAVR (Transcatheter Aortic Valve Replacement),1 Drs. Novak and Parulkar concisely elucidate a number of points in the care of TAVR patients. In particular, they present a thoughtful analysis of the current data on choice of anesthetic for these cases. While performing TAVR under sedation seems to be growing in popularity, there are lingering concerns as to whether this is truly the best practice. In addition to the authors’ points, I would opine that there is an element of added risk attendant to employing sedation rather than general anesthesia.
While TAVR under MAC appears safe, and serious problems are infrequent, they are problems for which we should be ready. Almost nothing in our daily practice is usually a problem, but prudent anesthetic practice means preparing for worst-case scenarios, not just the usual scenarios. In a TAVR, that worst-case scenario is cataclysmic hemodynamic collapse necessitating emergent cardiopulmonary bypass. Neglecting to secure the airway and monitor with TEE leaves us unequivocally under-prepared for that scenario, in which seconds truly matter.
Nathaniel F. Simon, MD
Chief, Department of Anesthesia
Sutter Medical Center Sacramento
- Novak TE, Parulkar S. The anesthesia professional’s role in patient safety during TAVR (transcatheter aortic valve replacement). APSF Newsletter2017; 31:73–75.