A review of novel structural heart procedures for the anesthesiologist.

Abstract

Purpose of review: There has been significant growth in the volume, complexity, and types of transcatheter cardiac interventions for valvular heart disease over the last 10 years. This review is intended to cover both common structural heart procedures, as well as recent advancements, and the anesthetic considerations of these procedures.

Recent findings: While contextualizing within a historical perspective, the review covers mitral and tricuspid valve transcatheter edge-to-edge repair, transcatheter mitral, and tricuspid valve replacement, with focus on valve-in-valve, valve-in-ring, and valve-in-native procedures, laceration of the anterior mitral leaflet to prevent outflow obstruction, septal scoring along the midline endocardium, transcatheter aortic valve implantation with focus on bioprosthetic, or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction. Procedures reviewed are summarized in Table 1.

Summary: To provide comprehensive care, anesthesiologists should have an understanding of the indications, population, and key procedural steps of novel structural heart interventions.