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J Cardiothorac Vasc Anesth. 2016 Oct;30(5):1238-43. doi: 10.1053/j.jvca.2016.05.034. Epub 2016 May 21.

Outcome After General Anesthesia Versus Monitored Anesthesia Care in Transfemoral Transcatheter Aortic Valve Replacement.

Author information

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.

KEYWORDS:

TAVI; TAVR; aortic valve stenosis; general anesthesia; local anesthesia; minimalist approach; monitored anesthesia care; transcatheter aortic valve replacement

PMID:
27495961
DOI:
10.1053/j.jvca.2016.05.034
[Indexed for MEDLINE]

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