In Japan there has been a rapid increase in transcatheter aortic valve implantation (TAVI) patients and centers since the introduction of TAVI into clinical practice on October 2013. TAVI has become a safe and indispensable treatment option for patients with severe symptomatic aortic stenosis who are at high or prohibitive surgical risk. Surgical aortic valve replacement (SAVR) remains the gold standard for patients at low or intermediate operative risk. However, TAVI has currently emerged as a qualified alternative to SAVR in the treatment of those patients although the long-term durability of TAVI devices remain unanswered. Here, we will focus on the current status and future perspectives for TAVI procedures.

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Life threating complications, like annulus rupture which occurs at transcatheter aortic valve implantation (TAVI), are getting rare these days. As a result of randomized controlled trials, indication of TAVI is expanding to low-risk cases. Survival is now a matter of course; improvement of long-term quality of life after the procedure is the prime focus. To achieve this goal, handling of complications previously regarded as insignificant, like anemia, acute kidney injury, stroke and respiratory dysfunction should be the main stream for management. In this review these new “significant” complications are reviewed.

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A-57-year-old woman with Eisenmenger’s syndrome due to ASD was underwent cystoscopic biopsy and ureteroscopy under general anesthesia. The patient had been treated with warfarin, PDE 5 inhibitor, endothelin receptor antagonist, and PGI2. The patient was NHYA class 3 due to hypoxemia (SpO2 75% with O2 3 L/min) and right heart failure. Pulmonary vascular resistance revealed very little, if any, response to either one or combination of oxygen and nitric oxide inhalation. To maintain systemic vascular resistance and venous return, general anesthesia was performed with spontaneous breathing using laryngeal mask airway. The perioperative hemodynamics including right-to-left shunt balance was maintained. In anesthetic management in an adult patient with Eisenmenger’s syndrome, general anesthesia with laryngeal mask airway, which can maintain spontaneous ventilation, can be a useful option.

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