Paola D'Errigo1, Marco Ranucci2, Remo Daniel Covello3, Fausto Biancari4, Stefano Rosato5, Marco Barbanti6, Francesco Onorati7, Corrado Tamburino6, Gennaro Santoro8, Claudio Grossi9, Francesco Santini10, Katia Bontempi11, Danilo Fusco11, Fulvia Seccareccia9. 1. National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy. 2. Department of Cardiothoracic and Vascular Anesthesia and ICU-IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy. 3. Department of Anesthesia and Intensive Care, Ospedale di Busto Arsizio, Varese, Italy. 4. Department of Surgery, Oulu University Hospital, Oulu, Finland. 5. National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy. Electronic address: stefano.rosato@iss.it. 6. Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy. 7. Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy. 8. Division of Cardiology, Careggi Hospital, Florence, Italy. 9. Division of Cardiac Surgery, ASO S. Croce e Carle, Cuneo, Italy. 10. Division of Cardiac Surgery, IRCCS University Hospital San Martino IST Genova, Genova, Italy. 11. Department of Epidemiology, Lazio Regional Health Service, Rome, Italy.
Abstract
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.
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.
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: Ewa M Kucewicz-Czech; Leszek Machej; Kazimierz Kiermasz; Andrzej Węglarzy; Maria Damps; Damian Hudziak; Radosław Gocoł; Andrzej Ochała; Radosław Parma Journal: Kardiochir Torakochirurgia Pol Date: 2021-01-15