Gianni Dall'Ara1, Helene Eltchaninoff2, Neil Moat1, Cécile Laroche3, Javier Goicolea4, Gian Paolo Ussia5, Petr Kala6, Peter Wenaweser7, Marian Zembala8, Georg Nickenig9, Thomas Snow10, Susanna Price1, Eduardo Alegria Barrero11, Rodrigo Estevez-Loureiro12, Bernard Iung13, José Luis Zamorano14, Gerhard Schuler15, Ottavio Alfieri16, Bernard Prendergast17, Peter Ludman18, Stephan Windecker7, Manel Sabate19, Martine Gilard20, Adam Witkowski21, Haim Danenberg22, Erwin Schroeder23, Francesco Romeo5, Carlos Macaya24, Genevieve Derumeaux25, Alessio Mattesini1, Luigi Tavazzi26, Carlo Di Mario27. 1. NIHR Cardiovascular BRU, Royal Brompton Hospital, London, United Kingdom. 2. University Hospital, Rouen, France. 3. EurObservational Reasearch Progamme Department, European Society of Cardiology, Sophia-Antipolis, France. 4. Hospital Universita Puerta de Hierro, Madrid, Spain. 5. University of Rome Tor Vergata, Rome, Italy. 6. Masaryk University, University Hospital Brno, Brno, Czech Republic. 7. Bern University Hospital, Bern, Switzerland. 8. Silesian Centre for Heart Disease, Zabrze, Poland. 9. University Hospital, Bonn, Germany. 10. St. Thomas' Hospital, London, United Kingdom. 11. Hospital Universitario de Torrejon, Madrid, Spain. 12. Complejo Asistencial Universitario de Leon, Leon, Spain. 13. Bichat Hospital, Paris, France. 14. Hospital Universitario Ramon y Cajall, Madrid, Spain. 15. Herzzentrum Leipzig Abt. Kardiologie und Angiologie, Leipzig, Germany. 16. Ospedale San Raffaele, Milan, Italy. 17. John Radcliffe Hospital, Oxford, United Kingdom. 18. Queen Elizabeth Hospital, Birmingham, United Kingdom. 19. Thorax Institute, Hospital Clinic, Barcelona, Spain. 20. Centre Hospitalier Universitaire (CHU) Brest, Brest, France. 21. Institute of Cardiology, Warsaw, Poland. 22. Hadassah-Hebrew University Medical Centre, Jerusalem, Israel. 23. UCL de Mont-Godinne, Yvoir, Belgium. 24. Clinico 'San Carlos' University Hospital, Madrid, Spain. 25. University of Lyon, Lyon, France. 26. Maria Cecilia Hospital GVM Care & Research, Ettore Sansavini Health Science Foundation, Cotignola, Italy. 27. NIHR Cardiovascular BRU, Royal Brompton Hospital, London, United Kingdom. Electronic address: c.dimario@rbht.nhs.uk.
Abstract
BACKGROUND: There is great variability for the type of anaesthesia used during TAVI, with no clear consensus coming from comparative studies or guidelines. We sought to detect regional differences in the anaesthetic management of patients undergoing transcatheter aortic valve implantation (TAVI) in Europe and to evaluate the relationship between type of anaesthesia and in-hospital and 1 year outcome. METHODS: Between January 2011 and May 2012 the Sentinel European TAVI Pilot Registry enrolled 2807 patients treated via a transfemoral approach using either local (LA-group, 1095 patients, 39%) or general anaesthesia (GA-group, 1712 patients, 61%). RESULTS: A wide variation in LA use was evident amongst the 10 participating countries. The use of LA has increased over time (from a mean of 37.5% of procedures in the first year, to 57% in last 6 months, p<0.01). MI, major stroke as well as in-hospital death rate (7.0% LA vs 5.3% GA, p=0.053) had a similar incidence between groups, confirmed in multivariate regression analysis after adjusting for confounders. Dividing our population in tertiles according to the Log-EuroSCORE we found similar mortality under LA, whilst mortality was higher in the highest risk tertile under GA. Survival at 1 year, compared by Kaplan-Meier analysis, was similar between groups (log-rank: p=0.1505). CONCLUSIONS: Selection of anaesthesia appears to be more influenced by national practice and operator preference than patient characteristics. In the absence of an observed difference in outcomes for either approach, there is no compelling argument to suggest that operators and centres should change their anaesthetic practice.
BACKGROUND: There is great variability for the type of anaesthesia used during TAVI, with no clear consensus coming from comparative studies or guidelines. We sought to detect regional differences in the anaesthetic management of patients undergoing transcatheter aortic valve implantation (TAVI) in Europe and to evaluate the relationship between type of anaesthesia and in-hospital and 1 year outcome. METHODS: Between January 2011 and May 2012 the Sentinel European TAVI Pilot Registry enrolled 2807 patients treated via a transfemoral approach using either local (LA-group, 1095 patients, 39%) or general anaesthesia (GA-group, 1712 patients, 61%). RESULTS: A wide variation in LA use was evident amongst the 10 participating countries. The use of LA has increased over time (from a mean of 37.5% of procedures in the first year, to 57% in last 6 months, p<0.01). MI, major stroke as well as in-hospital death rate (7.0% LA vs 5.3% GA, p=0.053) had a similar incidence between groups, confirmed in multivariate regression analysis after adjusting for confounders. Dividing our population in tertiles according to the Log-EuroSCORE we found similar mortality under LA, whilst mortality was higher in the highest risk tertile under GA. Survival at 1 year, compared by Kaplan-Meier analysis, was similar between groups (log-rank: p=0.1505). CONCLUSIONS: Selection of anaesthesia appears to be more influenced by national practice and operator preference than patient characteristics. In the absence of an observed difference in outcomes for either approach, there is no compelling argument to suggest that operators and centres should change their anaesthetic practice.
Authors: Constanze Ehret; Rolf Rossaint; Ann Christina Foldenauer; Christian Stoppe; Ana Stevanovic; Katharina Dohms; Marc Hein; Gereon Schälte Journal: BMJ Open Date: 2017-09-25 Impact factor: 2.692
Authors: Kerstin Piayda; Katharina Hellhammer; Jens Erik Nielsen-Kudsk; Boris Schmidt; Patrizio Mazzone; Sergio Berti; Sven Fischer; Juha Lund; Matteo Montorfano; Paolo Della Bella; Ryan Gage; Tobias Zeus Journal: BMJ Open Date: 2021-03-24 Impact factor: 2.692
Authors: Matthias Lutz; David Messika-Zeitoun; Tanja K Rudolph; Eberhard Schulz; Jeetendra Thambyrajah; Guy Lloyd; Alexander Lauten; Norbert Frey; Jana Kurucova; Martin Thoenes; Cornelia Deutsch; Peter Bramlage; Richard Paul Steeds Journal: Open Heart Date: 2020-09