Intracardiac echocardiography for guidance of transcatheter XXXX under monitored sedation: a solution to a dilemma?

@entity1 @entity9009 @entity2478 @entity1563 @entity886 @entity397 @entity340 @entity1580
UNASSIGNED: Transcatheter @entity886 (TAVI) has been established as a valuable alternative to surgical aortic valve replacement in @entity1 deemed to have high or prohibitive perioperative risk. However, there are several technical constraints and procedural risks inherent to TAVI. These risks include @entity397 , @entity9009 , @entity1580 , @entity1563 , and dislodgement or migration of the valve prosthesis to the aorta or the left ventricle (LV). Other complications may be @entity340 and subsequent @entity2478 . Most complications cannot be detected at an early stage without echocardiographic guidance. Although not addressed by current guidelines, some European centres have advocated a 'minimalist' approach with exclusively fluoroscopic and angiographic guidance. Transoesophageal echocardiography (TEE), including real-time three-dimensional (RT-3D) imaging, has been established as a standard approach for peri-interventional guidance of TAVI. However, TEE monitoring almost always necessitates general anaesthesia and endotracheal intubation. A potential alternative to TEE is intracardiac echocardiography (ICE) that may provide a solution to a common dilemma: the most important advantage of ICE being the compatibility with monitored anaesthesia care without endotracheal intubation. Other advantages of ICE include uninterrupted monitoring, no fluoroscopic interference, and precise Doppler-based assessment of pulmonary artery pressures. Limitations of ICE include the need for additional venous access, the learning curve associated with a new device, and potentially increased cost.
