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 |
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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 |
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