VOLUME 27, ISSUE 2

As with the development of most new devices, the costs associated with TAVR are significant. While costs initially outweighed savings, some argued that the costs per life-year in otherwise non-operable patients were comparable to other accepted cardiovascular techniques. However, as presented at the 2015 Society of Cardiovascular Anesthesiologists meeting, when a holistic approach to “fast-tracking” a patient through the peri-TAVR period was employed, significant cost savings may be possible.4 Patient selection, anesthetic management, and postoperative care profoundly impact the likelihood of success of a cost effective fast-track regimen.

In conclusion, TAVR is becoming increasingly widespread as research demonstrates its effectiveness and durability in a broader range of patients. The devices are evolving, increasing the safety while decreasing the invasiveness of the procedure, and the anesthetic management of TAVR continues to change as well. Anesthesiologists should remain active members of the valve team in order to keep pace with this developing field.

  1. Cribier A. Percutaneous Transcatheter Implantation of an Aortic Valve Prosthesis for Calcific Aortic Stenosis: First Human Case Description. Circulation. 2002;106(24):3006–3008.
  2. Kodali SK, Williams MR, Smith CR, et al. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N
    Engl J Med. 2012;366(18):1686–1695.
  3. Mack MJ, Leon MB, Smith CR et al. 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial. The Lancet. Epub March 2015.
  4. Marcantuono R, Gutsche J, Burke-Julien M, et al. Rationale, development, implementation, and initial results of a fast track protocol for transfemoral transcatheter aortic valve replacement (TAVR). Catheter Cardiovasc Interv. 2015;85(4):648–654.

 

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