N Patrick Mayr1, Gunther Wiesner2, Oliver Husser3, Michael Joner3, Jonathan Michel3, Jürgen Knorr2, Constanza Pellegrini3, Sabine Bleiziffer4, Heribert Schunkert5, Rüdiger Lange6, Peter Tassani-Prell2. 1. Institut für Anästhesiologie, Deutsches Herzzentrum München, Technische Universität München, Germany. Electronic address: patrick.mayr@tum.de. 2. Institut für Anästhesiologie, Deutsches Herzzentrum München, Technische Universität München, Germany. 3. Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Germany. 4. Klinik für Herz- und Gefäßchirurgie, Deutsches Herzzentrum München, Technische Universität München, Germany. 5. Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Germany; DZHK, partner site Munich Heart Alliance, Munich, Germany. 6. Klinik für Herz- und Gefäßchirurgie, Deutsches Herzzentrum München, Technische Universität München, Germany; DZHK, partner site Munich Heart Alliance, Munich, Germany.
Abstract
BACKGROUND: Transfemoral TAVR (tf-TAVR) under conscious sedation (CS) has become popular. The need of anesthesiologic support during tf-TAVR has been questioned. Critical events during the procedure might require immediate action. We analyzed the frequency of periprocedural critical adverse events (CAE) during tf-TAVR with CS in our institution. METHODS: Tf-TAVR has been performed at our institution since 2007. We excluded patients from the first four years to minimize the influence of any learning curve. CAE were defined as occurrence of 1.) "CPR", 2.) "defibrillation", 3.) "emergency extracorporeal circulation (ECC)" and 4.) "conversion to general anesthesia (GA) not related to 1.)-3.)". Data was prospectively collected in our AVIATOR TAVR registry. RESULTS: 601 patients were analyzed retrospectively. Overall, CAE were recorded in 54 patients (9%). CPR was necessary in 12 patients (2%) and defibrillation in 10 patients (1.6%). ECC was rarely needed (n = 2, 0.3%). Conversion to GA was necessary in 34 patients (5.65%). Procedure-related conversion was necessary in 10 patients. With 24 patients, sedation-related conversion occurred more frequently. Unrest and pain were the most common reasons for conversion (n = 13, 2%) and respiratory distress in 11 patients (2%). Catecholaminergic support was needed in 269 (45%) patients. Vasopressors were more often applied (n = 249, 41%) than inotropes (n = 59, 10%). CONCLUSION: Even in a high-volume center, CAE may occur in nearly every tenth patient. Conversion to GA was the most common CAE. Catecholaminergic support (primary vasopressor support) was needed in nearly every second patient. These points underline the necessity of a cardiac anaesthesiologist to be in the room during the procedure. SUMMARY: Despite experience, critical adverse events (CAE) still occur in TAVR patients. We analyzed the occurrence of CAE and the need for catecholaminergic support in sedated TAVR patients.
BACKGROUND: Transfemoral TAVR (tf-TAVR) under conscious sedation (CS) has become popular. The need of anesthesiologic support during tf-TAVR has been questioned. Critical events during the procedure might require immediate action. We analyzed the frequency of periprocedural critical adverse events (CAE) during tf-TAVR with CS in our institution. METHODS: Tf-TAVR has been performed at our institution since 2007. We excluded patients from the first four years to minimize the influence of any learning curve. CAE were defined as occurrence of 1.) "CPR", 2.) "defibrillation", 3.) "emergency extracorporeal circulation (ECC)" and 4.) "conversion to general anesthesia (GA) not related to 1.)-3.)". Data was prospectively collected in our AVIATOR TAVR registry. RESULTS: 601 patients were analyzed retrospectively. Overall, CAE were recorded in 54 patients (9%). CPR was necessary in 12 patients (2%) and defibrillation in 10 patients (1.6%). ECC was rarely needed (n = 2, 0.3%). Conversion to GA was necessary in 34 patients (5.65%). Procedure-related conversion was necessary in 10 patients. With 24 patients, sedation-related conversion occurred more frequently. Unrest and pain were the most common reasons for conversion (n = 13, 2%) and respiratory distress in 11 patients (2%). Catecholaminergic support was needed in 269 (45%) patients. Vasopressors were more often applied (n = 249, 41%) than inotropes (n = 59, 10%). CONCLUSION: Even in a high-volume center, CAE may occur in nearly every tenth patient. Conversion to GA was the most common CAE. Catecholaminergic support (primary vasopressor support) was needed in nearly every second patient. These points underline the necessity of a cardiac anaesthesiologist to be in the room during the procedure. SUMMARY: Despite experience, critical adverse events (CAE) still occur in TAVR patients. We analyzed the occurrence of CAE and the need for catecholaminergic support in sedated TAVR patients.
Authors: N Patrick Mayr; Gunther Wiesner; Angela Kretschmer; Johannes Brönner; Herbert Hoedlmoser; Oliver Husser; Albert M Kasel; Rüdiger Lange; Peter Tassani-Prell Journal: PLoS One Date: 2019-01-30 Impact factor: 3.240
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