Outcome After General Anesthesia Versus Monitored Anesthesia Care in Transfemoral Transcatheter Aortic Valve Replacement

Autor: D'Errigo, P, Ranucci, M, Covello, R, Biancari, F, Rosato, S, Barbanti, M, Onorati, F, Tamburino, C, Santoro, G, Grossi, C, Santini, F, Bontempi, K, Fusco, D, Seccareccia, F, Observant Research Group, Ruvolo, G, Nardi, P, Pisano, C
Rok vydání: 2016
Předmět:
Male
medicine.medical_treatment
aortic valve stenosis
030204 cardiovascular system & hematology
law.invention
Cohort Studies
0302 clinical medicine
Valve replacement
minimalist approach
030202 anesthesiology
law
80 and over
Anesthesia
Local anesthesia
Prospective Studies
Prospective cohort study
Intraoperative
Aged
80 and over
Intensive care unit
Survival Rate
Treatment Outcome
Local
Italy
Aortic valve stenosis
Female
Cardiology and Cardiovascular Medicine
medicine.medical_specialty
Monitoring
general anesthesia
local anesthesia
monitored anesthesia care
TAVI
TAVR
transcatheter aortic valve replacement
Anesthesia
General
Anesthesia
Local
Humans
Length of Stay
Monitoring
Intraoperative
Propensity Score
Transcatheter Aortic Valve Replacement
Anesthesiology and Pain Medicine
03 medical and health sciences
medicine
General
Survival rate
Aged
business.industry
Settore MED/23 - Chirurgia Cardiaca
medicine.disease
Surgery
Stenosis
business
Complication
Zdroj: Journal of Cardiothoracic and Vascular Anesthesia. 30:1238-1243
ISSN: 1053-0770
Popis: Objective To evaluate outcomes of monitored anesthesia care (MAC) compared with general anesthesia (GA) in patients undergoing transfemoral transcatheter aortic valve replacement (TAVR). Design Secondary analysis from the observational and prospective OBSERVANT (OBservational Study of Effectiveness of avR–taVi procedures for severe Aortic steNosis Treatment) study. Setting Multicenter study, including Italian hospitals performing TAVR interventions. Participants One thousand four hundred ninety-four patients with severe and symptomatic aortic stenosis. Interventions Transfemoral TAVR under general or local anesthesia. Measurements and Main Results A propensity score procedure was applied, and 310 pairs were matched with similar baseline characteristics (EuroSCORE II: local anesthesia 6.6±5.9% v general anesthesia 7.0±7.7%, p = 0.430). MAC was associated with similar 30-day mortality compared with GA (3.9% v 4.8%, p = 0.564). TAVR was performed under MAC without any increased risk of other adverse events. The risk of paravalvular regurgitation≥mild was similar between the study groups (MAC 49.5% v general anesthesia 57.0%, p = 0.858). Two patients receiving on MAC had severe paravalvular regurgitation, whereas this complication was not observed after GA. Permanent pacemaker implantation was 19.1% in the MAC group v 14.8% in the GA group (p = 0.168). Mean intensive care unit stay was 3.5 days for the GA group v 2.9 days for the MAC group (p = 0.086). A similar 3-year survival rate was observed (MAC 69.4% v GA 69.9%, p = 0.966). Conclusions Transfemoral TAVR can be performed under MAC with similar immediate and late outcomes as compared with GA. A possible risk of severe paravalvular regurgitation and pacemaker implantation with TAVR under MAC requires further investigation.
Databáze: OpenAIRE
Externí odkaz: