Nicolas Debry1, Cédric Delhaye1, Alexandre Azmoun2, Ramzi Ramadan2, Sahbi Fradi2, Philippe Brenot2, Arnaud Sudre1, Mouhamed Djahoum Moussa1, Didier Tchetche3, Said Ghostine2, Darren Mylotte4, Thomas Modine5. 1. Heart Team, Cardiology and Cardiovascular Surgery Departments, Institut Cardiopulmonaire, CHRU Lille, Lille, France. 2. Heart Team, Cardiology and Cardiovascular Surgery Departments, Centre Médico-Chirurgical Marie Lannelongue (CCML), Le Plessis-Robinson, France. 3. Clinique Pasteur, Toulouse, France. 4. Galway University Hospitals, Galway, Ireland. 5. Heart Team, Cardiology and Cardiovascular Surgery Departments, Institut Cardiopulmonaire, CHRU Lille, Lille, France. Electronic address: t1modine@yahoo.fr.
Abstract
OBJECTIVES: The study sought to assess the safety and efficacy of a minimally invasive strategy (MIS) (local anesthesia and conscious sedation) compared to general anesthesia (GA) among the largest published cohort of patients undergoing transcarotid transcatheter aortic valve replacement (TAVR). BACKGROUND: Transcarotid TAVR has been shown to be feasible and safe. There is, however, no information pertaining to the mode anesthesia in these procedures. METHODS: Between 2009 and 2014, 174 patients underwent transcarotid TAVR at 2 French centers. All patients were unsuitable for transfemoral TAVR due to severe peripheral vascular disease. An MIS was undertaken in 29.8% (n = 52) and GA in 70.1% (n = 122). One-year clinical outcomes were available in all patients and were described according to the Valve Academic Research Consortium-2 consensus. RESULTS: Transcarotid vascular access and transcatheter valve deployment was successful in all cases. Thirty-day mortality was 7.4% (n = 13) and 1-year all-cause and cardiovascular mortality were 12.6% (n = 22) and 8.0% (n = 14), respectively. According to the type of anesthesia, there was no between group difference in 30-day mortality (GA 7.3% vs. MIS 7.6%; p = 0.94), 1-year mortality (GA 13.9% vs. MIS 9.6%; p = 0.43), 1-month clinical efficacy (GA 85.2% vs. MIS 94.2%; p = 0.09), and early safety (GA 77.8% vs. MIS 86.5%; p = 0.18). There were 10 (5.7%) periprocedural cerebrovascular events: 4 strokes (2.2%) and 6 transient ischemic attacks (3.4%) among those treated with GA. There was neither stroke nor transient ischemic attack in the MIS group (p < 0.001). CONCLUSIONS: The transcarotid approach for TAVR is feasible using general or local anesthesia. A higher rate of perioperative strokes was observed with GA.
OBJECTIVES: The study sought to assess the safety and efficacy of a minimally invasive strategy (MIS) (local anesthesia and conscious sedation) compared to general anesthesia (GA) among the largest published cohort of patients undergoing transcarotid transcatheter aortic valve replacement (TAVR). BACKGROUND: Transcarotid TAVR has been shown to be feasible and safe. There is, however, no information pertaining to the mode anesthesia in these procedures. METHODS: Between 2009 and 2014, 174 patients underwent transcarotid TAVR at 2 French centers. All patients were unsuitable for transfemoral TAVR due to severe peripheral vascular disease. An MIS was undertaken in 29.8% (n = 52) and GA in 70.1% (n = 122). One-year clinical outcomes were available in all patients and were described according to the Valve Academic Research Consortium-2 consensus. RESULTS:Transcarotid vascular access and transcatheter valve deployment was successful in all cases. Thirty-day mortality was 7.4% (n = 13) and 1-year all-cause and cardiovascular mortality were 12.6% (n = 22) and 8.0% (n = 14), respectively. According to the type of anesthesia, there was no between group difference in 30-day mortality (GA 7.3% vs. MIS 7.6%; p = 0.94), 1-year mortality (GA 13.9% vs. MIS 9.6%; p = 0.43), 1-month clinical efficacy (GA 85.2% vs. MIS 94.2%; p = 0.09), and early safety (GA 77.8% vs. MIS 86.5%; p = 0.18). There were 10 (5.7%) periprocedural cerebrovascular events: 4 strokes (2.2%) and 6 transient ischemic attacks (3.4%) among those treated with GA. There was neither stroke nor transient ischemic attack in the MIS group (p < 0.001). CONCLUSIONS: The transcarotid approach for TAVR is feasible using general or local anesthesia. A higher rate of perioperative strokes was observed with GA.
Authors: Damian Hudziak; Wojciech Wańha; Radosław Gocoł; Radosław Parma; Andrzej Ochała; Grzegorz Smolka; Joanna Ciosek; Tomasz Darocha; Marek A Deja; Wojciech Wojakowski Journal: Postepy Kardiol Interwencyjnej Date: 2021-03-27 Impact factor: 1.426
Authors: Lukas Stastny; Christoph Krapf; Julia Dumfarth; Simone Gasser; Axel Bauer; Guy Friedrich; Bernhard Metzler; Gudrun Feuchtner; Agnes Mayr; Michael Grimm; Nikolaos Bonaros Journal: Front Cardiovasc Med Date: 2022-03-04