One of the most dramatic and far-reaching advancements in surgical care in recent years is happening right now in the field of structural heart disease, and the impact on the anesthesiologist is significant.

Similar to the development of coronary stents and endovascular aortic procedures, cardiac surgeons and interventional cardiologists are now using a number of new, minimally invasive percutaneous interventions on valves and other structures of the heart, sparing many patients the need for open-heart surgery. For these procedures, the rate of technological advancement has been remarkable, and the role of the anesthesiologist is rapidly evolving.

The most current example is transcatheter aortic valve replacement (TAVR). The first procedure was performed in 2002 in France on a patient with aortic stenosis considered inoperable, too sick for cardiac operation. Clinical trials for high-risk patients began in the United States in...

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