Atsushi Oguri1, Masanori Yamamoto2, Gauthier Mouillet1, Martine Gilard1, Marc Laskar1, Helene Eltchaninoff1, Jean Fajadet1, Bernard Iung1, Patrick Donzeau-Gouge1, Pascal Leprince1, Alain Leguerrier1, Alain Prat1, Michel Lievre1, Karine Chevreul1, Jean-Luc Dubois-Rande1, Romain Chopard1, Eric Van Belle1, Toshiaki Otsuka1, Emmanuel Teiger1. 1. From the Centre Hospitalier Universitaire (CHU) Henri Mondor, Creteil, France (A.O., M.Y., G.M., K.C., J.-L.D.-R., E.T.); Centre Hospitalier Universitaire Brest, Brest, France (M.G.); Centre Hospitalier Universitaire Dupuytren, Limoges, France (M. Laskar); Hopital Charles Nicolle, University of Rouen, INSERM Unite 1096, Rouen, France (H.E.); Clinique Pasteur, Toulouse, France (J.F.); Bichat Hospital, Paris, France (B.I.); Insitut Jacques Cartier, Massy, France (P.D.-G.); Pitie-Salpetriere Hospital, Paris, France (P.L.); Centre Hospitalier Universitaire Rennes, Rennes, France (A.L.); Centre Hospitalier Universitaire Lille, Lille, France (A.P., E.V.B.); University Lyon 1, Lyon, France (M. Lievre); Centre Hospitalier Universitaire Besançon, Besançon, France (R.C.); and Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.). 2. From the Centre Hospitalier Universitaire (CHU) Henri Mondor, Creteil, France (A.O., M.Y., G.M., K.C., J.-L.D.-R., E.T.); Centre Hospitalier Universitaire Brest, Brest, France (M.G.); Centre Hospitalier Universitaire Dupuytren, Limoges, France (M. Laskar); Hopital Charles Nicolle, University of Rouen, INSERM Unite 1096, Rouen, France (H.E.); Clinique Pasteur, Toulouse, France (J.F.); Bichat Hospital, Paris, France (B.I.); Insitut Jacques Cartier, Massy, France (P.D.-G.); Pitie-Salpetriere Hospital, Paris, France (P.L.); Centre Hospitalier Universitaire Rennes, Rennes, France (A.L.); Centre Hospitalier Universitaire Lille, Lille, France (A.P., E.V.B.); University Lyon 1, Lyon, France (M. Lievre); Centre Hospitalier Universitaire Besançon, Besançon, France (R.C.); and Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.). masa-nori@nms.ac.jp emmanuel.teiger@hmn.aphp.fr.
Abstract
BACKGROUND: Transcatheter aortic valve implantation (TAVI) performed under local anesthesia (LA) is becoming increasingly common. We aimed to compare the clinical outcomes in patients who underwent transfemoral-TAVI under general anesthesia (GA) and LA. METHODS AND RESULTS: Data from 2326 patients in the French Aortic National CoreValve and Edwards 2 (FRANCE 2) registry who underwent transfemoral-TAVI were analyzed. During the study period, the percentage of LA procedures increased gradually from 14% in January 2010 to 59% in October 2011. The clinical outcomes for GA (n=1377) and LA (n=949) were compared. Numerous baseline characteristics differed between the 2 groups, and the use of transesophageal echocardiographic guidance was more common in GA than in LA (76.3% versus 16.9%; P<0.001). Device success and cumulative 30-day survival rates were similar in the 2 groups (97.6% versus 97.0%; P=0.41 and 91.6% versus 91.3%; P=0.69, respectively), whereas the incidence of postprocedural aortic regurgitation≥mild was significantly lower in GA than in LA (15.0% versus 19.1%; P=0.015). The groups were also analyzed using a propensity-matching model, including transesophageal echocardiographic usage (GA [n=401] versus LA [n=401]). This model indicated that there were no significant differences between the 2 groups in the rates of 30-day survival (GA [91.4%] versus LA [89.3%]; P=0.27] and postprocedural aortic regurgitation≥mild (GA [12.7%] versus LA [16.2%]; P=0.19). CONCLUSIONS: The less invasive transfemoral-TAVI under LA is preferred in clinical settings and seems to be acceptable; however, the higher incidence of postprocedural aortic regurgitation is emphasized. Therapeutic efforts should be made to reduce such complications during transfemoral-TAVI under LA.
BACKGROUND: Transcatheter aortic valve implantation (TAVI) performed under local anesthesia (LA) is becoming increasingly common. We aimed to compare the clinical outcomes in patients who underwent transfemoral-TAVI under general anesthesia (GA) and LA. METHODS AND RESULTS: Data from 2326 patients in the French Aortic National CoreValve and Edwards 2 (FRANCE 2) registry who underwent transfemoral-TAVI were analyzed. During the study period, the percentage of LA procedures increased gradually from 14% in January 2010 to 59% in October 2011. The clinical outcomes for GA (n=1377) and LA (n=949) were compared. Numerous baseline characteristics differed between the 2 groups, and the use of transesophageal echocardiographic guidance was more common in GA than in LA (76.3% versus 16.9%; P<0.001). Device success and cumulative 30-day survival rates were similar in the 2 groups (97.6% versus 97.0%; P=0.41 and 91.6% versus 91.3%; P=0.69, respectively), whereas the incidence of postprocedural aortic regurgitation≥mild was significantly lower in GA than in LA (15.0% versus 19.1%; P=0.015). The groups were also analyzed using a propensity-matching model, including transesophageal echocardiographic usage (GA [n=401] versus LA [n=401]). This model indicated that there were no significant differences between the 2 groups in the rates of 30-day survival (GA [91.4%] versus LA [89.3%]; P=0.27] and postprocedural aortic regurgitation≥mild (GA [12.7%] versus LA [16.2%]; P=0.19). CONCLUSIONS: The less invasive transfemoral-TAVI under LA is preferred in clinical settings and seems to be acceptable; however, the higher incidence of postprocedural aortic regurgitation is emphasized. Therapeutic efforts should be made to reduce such complications during transfemoral-TAVI under LA.
Authors: Jakob Ledwoch; Predrag Matić; Jennifer Franke; Sameer Gafoor; Stefan Bertog; Markus Reinartz; Laura Vaskelyte; Ilona Hofmann; Horst Sievert Journal: Clin Res Cardiol Date: 2015-09-16 Impact factor: 5.460
Authors: Florence Leclercq; Pierre Alain Meunier; Thomas Gandet; Jean-Christophe Macia; Delphine Delseny; Philippe Gaudard; Marc Mourad; Laurent Schmutz; Pierre Robert; François Roubille; Guillaume Cayla; Mariama Akodad Journal: J Clin Med Date: 2022-05-16 Impact factor: 4.964