Format

Send to

Choose Destination
JACC Cardiovasc Interv. 2016 Oct 24;9(20):2113-2120. doi: 10.1016/j.jcin.2016.08.013.

Transcarotid Transcatheter Aortic Valve Replacement: General or Local Anesthesia.

Author information

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.

KEYWORDS:

aortic stenosis; general anesthesia; local anesthesia; transcarotid access; transcatheter aortic valve replacement

PMID:
27765304
DOI:
10.1016/j.jcin.2016.08.013
[Indexed for MEDLINE]
Free full text

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center