Comparison of clinical outcomes with the utilization of monitored anesthesia care vs. general anesthesia in patients undergoing transcatheter aortic valve replacement.

Autor: Kiramijyan S; Section of Interventional Cardiology, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, D.C., Ben-Dor I; Section of Interventional Cardiology, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, D.C., Koifman E; Section of Interventional Cardiology, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, D.C., Didier R; Section of Interventional Cardiology, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, D.C., Magalhaes MA; Section of Interventional Cardiology, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, D.C., Escarcega RO; Section of Interventional Cardiology, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, D.C., Negi SI; Section of Interventional Cardiology, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, D.C., Baker NC; Section of Interventional Cardiology, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, D.C., Gai J; Section of Interventional Cardiology, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, D.C., Torguson R; Section of Interventional Cardiology, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, D.C., Okubagzi P; Section of Interventional Cardiology, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, D.C., Asch FM; Section of Interventional Cardiology, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, D.C., Wang Z; Section of Interventional Cardiology, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, D.C., Gaglia MA Jr; Section of Interventional Cardiology, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, D.C., Satler LF; Section of Interventional Cardiology, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, D.C., Pichard AD; Section of Interventional Cardiology, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, D.C., Waksman R; Section of Interventional Cardiology, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, D.C.. Electronic address: ron.waksman@medstar.net.
Jazyk: angličtina
Zdroj: Cardiovascular revascularization medicine : including molecular interventions [Cardiovasc Revasc Med] 2016 Sep; Vol. 17 (6), pp. 384-90. Date of Electronic Publication: 2016 Feb 09.
DOI: 10.1016/j.carrev.2016.02.003
Abstrakt: Background: There is no clear consensus in regard to the optimal anesthesia utilization during transcatheter aortic valve replacement (TAVR). The aim was to compare outcomes of transfemoral (TF) TAVR under monitored anesthesia care (MAC) vs. general anesthesia (GA) and evaluate the rates and causes of intra-procedural MAC failure.
Methods: All consecutive patients who underwent TF TAVR from April 2007 through March 2015 were retrospectively analyzed and dichotomized into two groups: TAVR under MAC vs. GA. The main endpoints of the study included 30-day and 1-year mortality, the rates and reasons for failure of MAC, in-hospital clinical safety outcomes, and post-procedural hospital and intensive care unit length-of-stays.
Results: A total of 533 patients (51% male, mean-age 83years) underwent TF TAVR under MAC (n=467) or GA (n=66). Fifty-six patients (12%) in the MAC group required conversion to GA. The MAC group had significantly shorter post-procedural hospital (6.0 vs. 7.9, p=0.023) and numerically shorter ICU (2.4 vs. 2.8, p=0.355) mean length-of-stays in days. The clinical safety outcomes were similar in both groups. Kaplan-Meier unadjusted cumulative in-hospital and 30-day mortality rates were higher in the GA group but similar in both groups at 1-year.
Conclusions: TF TAVR under MAC is feasible and safe, results in shorter hospital stays, can be performed in the majority of cases, and should be utilized as the default strategy. Trans-esophageal echocardiography utilization during TAVR with MAC is safe and feasible. The most common cause for conversion of MAC to GA is cardiac instability and hypotension. The complete heart team should be available at all times in case the need arises for a rapid conversion to GA.
(Copyright © 2016. Published by Elsevier Inc.)
Databáze: MEDLINE
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