The evolution of minimally invasive procedures has led to the development of the Percutaneous Transcatheter Procedures (PTP). PTP is a new therapeutic option for a subgroup of cardiac patients at very high risk of morbidity and mortality, especially if undergoing conventional surgical procedures. Patients with severe aortic and mitral valve disease frequently present with severely damaged additional organ systems, including heart and renal failure.

Anesthesiologists and nurse anesthetists from the Department of Cardiothoracic Anesthesiology (CTA) have been involved in the multidisciplinary collaborative management of these percutaneous procedures from the beginning. These procedures include transfemoral and transapical aortic valve replacements (Figure 1 and 2 and Video 1 and 2), mitral valve insufficiency repairs as well as paravalvular leak and septum defect repairs. CTA providers, with their unique experience and expertise in management of hemodynamic instability with invasive monitoring and TEE, are invaluable members of the team that includes cardiologists, cardiothoracic surgeons, perfusionists and nursing staff. Clear communication is crucial for the best patient outcomes in these intensely collaborative procedures.

Another important factor for success is adaptability and flexibility as many of these procedures are performed in a non-traditional environment. CTA providers adapt their anesthetic techniques to catheterization labs or hybrid operating rooms. The physical remoteness, the difficult design of the spaces for anesthetic care, and the unfamiliarity with the equipment in these locations presents unique challenges for anesthetic management. In addition, exposure to radiation presents a risk not only to the patient, but to all personnel involved with the patient care.

In September of 2010, the department recognized the efforts invested into organization and provision of care for PTPs by establishing The Section of Percutaneous Transcatheter Procedures. The goal is to continue improving patient care and training staff, cardiothoracic fellows and nurse anesthetists. The opportunities for enhancing the quality of life for these morbidly ill patients are significant. With advances in technology and experience, more patients have the possibility of minimally invasive cardiac procedures. CTA providers are in a unique position to "bridge" between cardiothoracic surgeons and cardiologist and provide an "anchor" for best possible patient outcomes.

We want to thank the whole team for their effort in making this program a success!