Current Anesthetic Care of Patients Undergoing Transcatheter Aortic Valve Replacement in Europe: Results of an Online Survey.

Autor: Trauzeddel RF; Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany., Nordine M; Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany., Balanika M; Department of Anesthesiology, Onassis Cardiac Surgery Center, Athens, Greece., Bence J; Department of Anaesthesia and Intensive Care, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom., Bouchez S; Department of Anesthesiology and Perioperative Medicine, Ghent University, Gent, Belgium., Ender J; Department of Anesthesiology and Intensive Care Medicine, Leipzig Heart Center, Leipzig, Germany., Erb JM; Department of Anesthesiology, University Hospital Basel, Basel, Switzerland., Fassl J; Institute of Cardiac Anesthesiology, University Heart Center Dresden, Dresden, Germany., Fletcher N; St Georges Hospital NHS Trust, London, United Kingdom; Cleveland Clinic, London, United Kingdom., Mukherjee C; Department of Anesthesiology and Intensive Care Medicine, HELIOS Heart Surgery Clinic Karlsruhe, Karlsruhe, Germany., Prabhu M; Cardiothoracic Anaesthesia and Intensive Care, Freeman Hospital, Newcastle upon Tyne, United Kingdom., van der Maaten J; Department of Anesthesiology, University Medical Center Groningen, Faculty of Medical Sciences, Groningen, The Netherlands., Wouters P; Department of Anesthesiology and Perioperative Medicine, Ghent University, Gent, Belgium., Guarracino F; Department of Anesthesiology and Critical Care Medicine, Azienda Ospedaliero-Universitatria Pisana, Pisa, Italy., Treskatsch S; Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany. Electronic address: sascha.treskatsch@charite.de.
Jazyk: angličtina
Zdroj: Journal of cardiothoracic and vascular anesthesia [J Cardiothorac Vasc Anesth] 2021 Jun; Vol. 35 (6), pp. 1737-1746. Date of Electronic Publication: 2020 Sep 07.
DOI: 10.1053/j.jvca.2020.09.088
Abstrakt: Objectives: Transcatheter aortic valve replacement (TAVR) has become an alternative treatment for patients with symptomatic aortic stenosis not eligible for surgical valve replacement due to a high periprocedural risk or comorbidities. However, there are several areas of debate concerning the pre-, intra- and post-procedural management. The standards and management for these topics may vary widely among different institutions and countries in Europe.
Design: Structured web-based, anonymized, voluntary survey.
Setting: Distribution of the survey via email among members of the European Association of Cardiothoracic Anaesthesiology working in European centers performing TAVR between September and December 2018.
Participants: Physicians.
Measurements and Main Results: The survey consisted of 25 questions, including inquiries regarding number of TAVR procedures, technical aspects of TAVR, medical specialities present, preoperative evaluation of TAVR candidates, anesthesia regimen, as well as postoperative management. Seventy members participated in the survey. Reporting members mostly performed 151-to-300 TAVR procedures per year. In 90% of the responses, a cardiologist, cardiac surgeon, cardiothoracic anesthesiologist, and perfusionist always were available. Sixty-six percent of the members had a national curriculum for cardiothoracic anesthesia. Among 60% of responders, the decision for TAVR was made preoperatively by an interdisciplinary heart team with a cardiothoracic anesthesiologist, yet in 5 countries an anesthesiologist was not part of the decision-making. General anesthesia was employed in 40% of the responses, monitored anesthesia care in 44%, local anesthesia in 23%, and in 49% all techniques were offered to the patients. In cases of general anesthesia, endotracheal intubation almost always was performed (91%). It was stated that norepinephrine was the vasopressor of choice (63% of centers). Transesophageal echocardiography guiding, whether performed by an anesthesiologist or cardiologist, was used only ≤30%. Postprocedurally, patients were transferred to an intensive care unit by 51.43% of the respondents with a reported nurse-to-patient ratio of 1:2 or 1:3, to a post-anesthesia care unit by 27.14%, to a postoperative recovery room by 11.43%, and to a peripheral ward by 10%.
Conclusion: The results indicated that requirements and quality indicators (eg, periprocedural anesthetic management, involvement of the anesthesiologist in the heart team, etc) for TAVR procedures as published within the European guideline are largely, yet still not fully implemented in daily routine. In addition, anesthetic TAVR management also is performed heterogeneously throughout Europe.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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