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Int J Cardiol. 2014 Dec 15;177(2):448-54. doi: 10.1016/j.ijcard.2014.09.025. Epub 2014 Sep 28.

Local and general anaesthesia do not influence outcome of transfemoral aortic valve implantation.

Author information

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.

KEYWORDS:

Anaesthesia; Aortic valve stenosis; Outcome; Transcatheter aortic valve implantation

PMID:
25443245
DOI:
10.1016/j.ijcard.2014.09.025
[Indexed for MEDLINE]

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