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Su X, Zhao Z, Zhang W, Tian Y, Wang X, Yuan X, Tian S. Sedation versus general anesthesia on all-cause mortality in patients undergoing percutaneous procedures: a systematic review and meta-analysis. BMC Anesthesiol 2024; 24:126. [PMID: 38565990 PMCID: PMC10985877 DOI: 10.1186/s12871-024-02505-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 03/20/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND The comparison between sedation and general anesthesia (GA) in terms of all-cause mortality remains a subject of ongoing debate. The primary objective of our study was to investigate the impact of GA and sedation on all-cause mortality in order to provide clarity on this controversial topic. METHODS A systematic review and meta-analysis were conducted, incorporating cohort studies and RCTs about postoperative all-cause mortality. Comprehensive searches were performed in the PubMed, EMBASE, and Cochrane Library databases, with the search period extending until February 28, 2023. Two independent reviewers extracted the relevant information, including the number of deaths, survivals, and risk effect values at various time points following surgery, and these data were subsequently pooled and analyzed using a random effects model. RESULTS A total of 58 studies were included in the analysis, with a majority focusing on endovascular surgery. The findings of our analysis indicated that, overall, and in most subgroup analyses, sedation exhibited superiority over GA in terms of in-hospital and 30-day mortality. However, no significant difference was observed in subgroup analyses specific to cerebrovascular surgery. About 90-day mortality, the majority of studies centered around cerebrovascular surgery. Although the overall pooled results showed a difference between sedation and GA, no distinction was observed between the pooled ORs and the subgroup analyses based on RCTs and matched cohort studies. For one-year all-cause mortality, all included studies focused on cardiac and macrovascular surgery. No difference was found between the HRs and the results derived from RCTs and matched cohort studies. CONCLUSIONS The results suggested a potential superiority of sedation over GA, particularly in the context of cardiac and macrovascular surgery, mitigating the risk of in-hospital and 30-day death. However, for the longer postoperative periods, this difference remains uncertain. TRIAL REGISTRATION PROSPERO CRD42023399151; registered 24 February 2023.
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Affiliation(s)
- Xuesen Su
- The First College for Clinical Medicine, Shanxi Medical University, No. 56 Xinjian South Road, Taiyuan, Shanxi, People's Republic of China
| | - Zixin Zhao
- College of Anesthesia, Shanxi Medical University, No. 56 Xinjian South Road, Taiyuan, Shanxi, People's Republic of China
| | - Wenjie Zhang
- Department of Anesthesiology, First Hospital of Shanxi Medical University, No. 85 Jiefang South Road, Taiyuan, Shanxi, People's Republic of China
| | - Yihe Tian
- John Muir College, University of California San Diego, 8775 Costa Verde Blvd, San Diego, CA, USA
| | - Xin Wang
- Department of Anesthesiology, First Hospital of Shanxi Medical University, No. 85 Jiefang South Road, Taiyuan, Shanxi, People's Republic of China
| | - Xin Yuan
- Department of Anesthesiology, First Hospital of Shanxi Medical University, No. 85 Jiefang South Road, Taiyuan, Shanxi, People's Republic of China
| | - Shouyuan Tian
- College of Anesthesia, Shanxi Medical University, No. 56 Xinjian South Road, Taiyuan, Shanxi, People's Republic of China.
- Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences No. 3, Workers' New Village, Xinghualing District, Taiyuan, Shanxi, People's Republic of China.
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Fadah K, Khalafi S, Corey M, Sotelo J, Farag A, Siddiqui T, Abolbashari M. Optimizing Anesthetic Selection in Transcatheter Aortic Valve Replacement: Striking a Delicate Balance between Efficacy and Minimal Intervention. Cardiol Res Pract 2024; 2024:4217162. [PMID: 38454917 PMCID: PMC10919973 DOI: 10.1155/2024/4217162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/27/2024] [Indexed: 03/09/2024] Open
Abstract
Patients with severe calcific native aortic valve stenosis (AS) who require valve replacement have two options, surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). TAVR was approved in late 2011 for extremely high-risk patients and was subsequently approved for high-risk (2012), intermediate-risk (2016), and low-risk (2019) patients. In 2019, TAVR procedures surpassed SAVR procedures for the first time in the United States. The approach to anesthesia for this procedure has also evolved. Initially, general anesthesia (GA) was preferred, but currently, conscious sedation (CS) is favored. This review aims to clarify the indications and contraindications for both approaches, as well as the advantages of one approach over the other. Recent studies show that conscious sedation has better outcomes in terms of all-cause mortality, procedure complications such as stroke, myocardial infarction, infection requiring antibiotics, acute kidney injury, and the need for inotropes or vasopressors.
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Affiliation(s)
- Kahtan Fadah
- Division of Cardiology, Department of Internal Medicine, Texas Tech University Health Sciences Center, 4800 Alberta Avenue, El Paso, TX 79905, USA
| | - Seyed Khalafi
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, 5001 El Paso Drive, El Paso, TX 79905, USA
| | - Miller Corey
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, 5001 El Paso Drive, El Paso, TX 79905, USA
| | - Jose Sotelo
- Department of Internal Medicine, Texas Tech University Health Sciences Center, 4800 Alberta Avenue, El Paso, TX 79905, USA
| | - Ahmed Farag
- Department of Internal Medicine, Texas Tech University Health Sciences Center, 4800 Alberta Avenue, El Paso, TX 79905, USA
| | - Tariq Siddiqui
- Tash Medical Clinic, 7812 Gateway Blvd E, El Paso, TX 79915, USA
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3
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Holzer RJ, Bergersen L, Thomson J, Aboulhosn J, Aggarwal V, Akagi T, Alwi M, Armstrong AK, Bacha E, Benson L, Bökenkamp R, Carminati M, Dalvi B, DiNardo J, Fagan T, Fetterly K, Ing FF, Kenny D, Kim D, Kish E, O'Byrne M, O'Donnell C, Pan X, Paolillo J, Pedra C, Peirone A, Singh HS, Søndergaard L, Hijazi ZM. PICS/AEPC/APPCS/CSANZ/SCAI/SOLACI: Expert Consensus Statement on Cardiac Catheterization for Pediatric Patients and Adults With Congenital Heart Disease. JACC Cardiovasc Interv 2024; 17:115-216. [PMID: 38099915 DOI: 10.1016/j.jcin.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Affiliation(s)
- Ralf J Holzer
- UC Davis Children's Hospital, Sacramento, California.
| | | | - John Thomson
- Johns Hopkins Children's Center, Baltimore, Maryland
| | - Jamil Aboulhosn
- UCLA Adult Congenital Heart Disease Center, Los Angeles, California
| | - Varun Aggarwal
- University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | | | - Mazeni Alwi
- Institut Jantung Negara, Kuala Lumpur, Malaysia
| | | | - Emile Bacha
- NewYork-Presbyterian Hospital, New York, New York
| | - Lee Benson
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | | - Thomas Fagan
- Children's Hospital of Michigan, Detroit, Michigan
| | | | - Frank F Ing
- UC Davis Children's Hospital, Sacramento, California
| | | | - Dennis Kim
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Emily Kish
- Rainbow Babies Children's Hospital, Cleveland, Ohio
| | - Michael O'Byrne
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Xiangbin Pan
- Cardiovascular Institute, Fu Wai, Beijing, China
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4
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Holzer RJ, Bergersen L, Thomson J, Aboulhosn J, Aggarwal V, Akagi T, Alwi M, Armstrong AK, Bacha E, Benson L, Bökenkamp R, Carminati M, Dalvi B, DiNardo J, Fagan T, Fetterly K, Ing FF, Kenny D, Kim D, Kish E, O'Byrne M, O'Donnell C, Pan X, Paolillo J, Pedra C, Peirone A, Singh HS, Søndergaard L, Hijazi ZM. PICS/AEPC/APPCS/CSANZ/SCAI/SOLACI: Expert Consensus Statement on Cardiac Catheterization for Pediatric Patients and Adults With Congenital Heart Disease. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101181. [PMID: 39131968 PMCID: PMC11307799 DOI: 10.1016/j.jscai.2023.101181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Affiliation(s)
- Ralf J Holzer
- UC Davis Children's Hospital, Sacramento, California
| | | | - John Thomson
- Johns Hopkins Children's Center, Baltimore, Maryland
| | - Jamil Aboulhosn
- UCLA Adult Congenital Heart Disease Center, Los Angeles, California
| | - Varun Aggarwal
- University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | | | - Mazeni Alwi
- Institut Jantung Negara, Kuala Lumpur, Malaysia
| | | | - Emile Bacha
- NewYork-Presbyterian Hospital, New York, New York
| | - Lee Benson
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | | - Thomas Fagan
- Children's Hospital of Michigan, Detroit, Michigan
| | | | - Frank F Ing
- UC Davis Children's Hospital, Sacramento, California
| | | | - Dennis Kim
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Emily Kish
- Rainbow Babies Children's Hospital, Cleveland, Ohio
| | - Michael O'Byrne
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Xiangbin Pan
- Cardiovascular Institute, Fu Wai, Beijing, China
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Yilmaz N, Gul YG, Ugurlucan M. Sedation with Ketamine-Propofol in Patients Undergoing Transcatheter Aortic Valve Implantation: A Comparative Retrospective Study on General Anesthesia. Curr Vasc Pharmacol 2024; 22:266-272. [PMID: 38284695 DOI: 10.2174/0115701611274790231221044147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 11/30/2023] [Accepted: 11/30/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is used for patients with severe aortic stenosis who are at high risk for surgery. Since these patients are elderly and have comorbidities, their management is of great importance. OBJECTIVES This retrospective study compares two anesthesia techniques during TAVI: sedation (ketamine and propofol) and general anesthesia. METHODS Patients with severe aortic stenosis undergoing TAVI during 2021 in our hospital were retrospectively screened. Demographic data, comorbidities, anesthesia management, complications, and mortality of the patients were obtained from the records. RESULTS There were 137 patients treated with TAVI; 74 (54%) patients had sedation and 63 (46%) had general anesthesia. When the anesthesia management was evaluated, no significant difference in mortality was observed between the patients who received general anesthesia and sedation. After univariate and multivariate logistic regression analyses were performed to investigate factors having an impact on mortality, anemia (only in univariate analysis) in the whole study population was a statistically significant risk factor for mortality in patients undergoing TAVI (p<0.014). CONCLUSION There was no significant difference in mortality in terms of anesthesia management. Anemia was a risk factor for mortality (only in univariate analysis) in the whole study population. We concluded that conscious sedation with ketamine and propofol is effective and safe for TAVI procedures compared to general anesthesia.
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Affiliation(s)
- Nurdan Yilmaz
- Department of Anesthesiology and Reanimation, Medipol Mega University Hospital, Istanbul, Turkey
| | - Yasar Gokhan Gul
- Department of Anesthesiology and Reanimation, Medipol Mega University Hospital, Istanbul, Turkey
| | - Murat Ugurlucan
- Department of Cardiovascular Surgery, Biruni University Faculty of Medicine, Istanbul, Turkey
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Bartel T. Intracardiac Echocardiography: Guiding Tool in Transcatheter Aortic Valve Replacement. JACC. ASIA 2023; 3:935-936. [PMID: 38155794 PMCID: PMC10751639 DOI: 10.1016/j.jacasi.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
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Coetzee E, Absalom AR. Pharmacokinetic and Pharmacodynamic Changes in the Elderly: Impact on Anesthetics. Anesthesiol Clin 2023; 41:549-565. [PMID: 37516494 DOI: 10.1016/j.anclin.2023.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2023]
Abstract
Anesthesiologists are increasingly required to care for frail elderly patients. A detailed knowledge of the influence of age on the pharmacokinetics and dynamics of the anesthetic drugs is essential for optimal safety and care. For most of the anesthetic drugs, the elderly need lower doses to achieve the same plasma concentrations, and at any given plasma and effect-site concentration, they will have more profound clinical effects than younger patients. Caution is required, with close monitoring of clinical effects and active titration of dose administration to achieve the desired level of effect, ideally following the "start low, go slow" principle.
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Affiliation(s)
- Ettienne Coetzee
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, D23, Observatory, Cape Town 7925, Republic of South Africa
| | - Anthony Ray Absalom
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Post Box 30.001, Groningen 9700 RB, the Netherlands.
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8
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Wang L, Liu Y, Gao H, Zhang B, Zhou S, Xie M, Sun X. Comparison of Safety and Effectiveness of Local or General Anesthesia after Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12020508. [PMID: 36675437 PMCID: PMC9866516 DOI: 10.3390/jcm12020508] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/26/2022] [Accepted: 12/31/2022] [Indexed: 01/11/2023] Open
Abstract
It remains controversial to choose anesthesia for transcatheter aortic valve implantation (TAVI). A meta-analysis of cohort studies was conducted to assess the efficacy and safety of local anesthesia (LA) compared to general anesthesia (GA) in TAVI. All relevant studies published from 1 January 2002, to 31 June 2022, were searched in Ovid, PubMed, Embase, Web of Science, and Cochrane Library. A total of 34 studies involving 23,480 patients were included in the meta-analysis. TAVI with LA was associated with a significant reduction in hospital stay [WMD = −2.48, 95% CI (−2.80, −2.16), p < 0.00001], operative [WMD = −12.25, 95% CI (−13.73, −10.78), p < 0.00001] and fluoroscopy time [WMD = −3.30, 95% CI (−5.40, −1.19), p = 0.002], and an increased risk of acute kidney injury [OR = 1.31, 95% CI (1.01, 1.69), p = 0.04] and a reduced incidence of major bleeding [OR = 0.59, 95% CI (0.46, 0.75), p < 0.0001] and the use of cardiovascular drugs [OR = 0.17, 95% CI (0.05, 0.57), p = 0.004]. No differences were found between LA and GA for 30-day mortality, procedural success rate, myocardial infarction, permanent pacemaker implantation, paravalvular leak, shock, and cerebrovascular events. Overall, 4.4% of LA converted to GA. Based on current evidence, our results suggested that LA strategies reduced hospital stay, operative time, fluoroscopy time, cardiovascular drug consumption, and major bleeding rates in patients undergoing TAVI but led to increased acute kidney injury rates. Further studies and randomized trials are required to verify the presented findings and to identify patients who might benefit from LA.
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Berkovitch A, Finkelstein A, Barbash IM, Kornowski R, Fefer P, Steinvil A, Vaknin Assa H, Danenberg H, Maor E, Guetta V, Segev A. Local Anesthesia versus Conscious Sedation among Patients Undergoing Transcatheter Aortic Valve Implantation-A Propensity Score Analysis. J Clin Med 2022; 11:jcm11113134. [PMID: 35683525 PMCID: PMC9181727 DOI: 10.3390/jcm11113134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/03/2022] [Accepted: 05/18/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Conscious sedation (CS) has been used successfully to treat patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) and as such is considered the standard anesthesia method. The local anesthesia (LA) only approach may be feasible and safe thanks to improvements in operators' experience. OBJECTIVE To evaluate differences between LA only versus CS approaches on short- and long-term outcomes among patients undergoing TAVI. METHODS We performed a propensity score analysis on 1096 patients undergoing TAVI for severe AS. Two hundred and seventy-four patients in the LA group were matched in a ratio of 1:3 with 822 patients in the CS group. The primary outcome was a 1-year mortality rate. Secondary outcomes included procedural and peri-procedural complication rates and in-hospital mortality. RESULTS Patients in the CS group had significantly higher rates of grade 2-3 acute kidney injury and were more likely to have had new left bundle branch block and high-degree atrioventricular block. Patients who underwent TAVI under CS had significantly higher in-hospital and 1-year mortality rates compared to LA (1.6% vs. 0.0% p-value = 0.036 and 8.5% vs. 3.3% p-value = 0.004, respectively). Kaplan-Meier's survival analysis showed that the cumulative probability of 1-year mortality was significantly higher among subjects undergoing CS compared to patients LA (p-value log-rank = 0.024). Regression analysis indicated that patients undergoing CS were twice more likely to die of at 1-year when compared to patients under LA (HR 2.18, 95%CI 1.09-4.36, p-value = 0.028). CONCLUSIONS As compared to CS, the LA-only approach is associated with lower rates of peri-procedural complications and 1-year mortality rates.
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Affiliation(s)
- Anat Berkovitch
- Division of Cardiology, Leviev Heart and Vascular Center, Chaim Sheba Medical Center, Tel-Hashomer 5262000, Israel; (A.B.); (I.M.B.); (P.F.); (E.M.); (V.G.)
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel; (A.F.); (R.K.); (A.S.); (H.V.A.)
| | - Ariel Finkelstein
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel; (A.F.); (R.K.); (A.S.); (H.V.A.)
- Division of Cardiology, Tel Aviv Medical Center, Tel Aviv 6423906, Israel
| | - Israel M. Barbash
- Division of Cardiology, Leviev Heart and Vascular Center, Chaim Sheba Medical Center, Tel-Hashomer 5262000, Israel; (A.B.); (I.M.B.); (P.F.); (E.M.); (V.G.)
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel; (A.F.); (R.K.); (A.S.); (H.V.A.)
| | - Ran Kornowski
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel; (A.F.); (R.K.); (A.S.); (H.V.A.)
- Division of Cardiology, Rabin Medical Center, Petach-Tikva 4941492, Israel
| | - Paul Fefer
- Division of Cardiology, Leviev Heart and Vascular Center, Chaim Sheba Medical Center, Tel-Hashomer 5262000, Israel; (A.B.); (I.M.B.); (P.F.); (E.M.); (V.G.)
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel; (A.F.); (R.K.); (A.S.); (H.V.A.)
| | - Arie Steinvil
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel; (A.F.); (R.K.); (A.S.); (H.V.A.)
- Division of Cardiology, Tel Aviv Medical Center, Tel Aviv 6423906, Israel
| | - Hana Vaknin Assa
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel; (A.F.); (R.K.); (A.S.); (H.V.A.)
- Division of Cardiology, Rabin Medical Center, Petach-Tikva 4941492, Israel
| | - Haim Danenberg
- The Heart Institute, Hadassah Ein-Karem Medical Center, The Hebrew University, Jerusalem 91120, Israel;
| | - Elad Maor
- Division of Cardiology, Leviev Heart and Vascular Center, Chaim Sheba Medical Center, Tel-Hashomer 5262000, Israel; (A.B.); (I.M.B.); (P.F.); (E.M.); (V.G.)
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel; (A.F.); (R.K.); (A.S.); (H.V.A.)
| | - Victor Guetta
- Division of Cardiology, Leviev Heart and Vascular Center, Chaim Sheba Medical Center, Tel-Hashomer 5262000, Israel; (A.B.); (I.M.B.); (P.F.); (E.M.); (V.G.)
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel; (A.F.); (R.K.); (A.S.); (H.V.A.)
| | - Amit Segev
- Division of Cardiology, Leviev Heart and Vascular Center, Chaim Sheba Medical Center, Tel-Hashomer 5262000, Israel; (A.B.); (I.M.B.); (P.F.); (E.M.); (V.G.)
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel; (A.F.); (R.K.); (A.S.); (H.V.A.)
- Correspondence: ; Tel.: +972-52-666-7581; Fax: +972-3-530-2683
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Erkan G, Ozyaprak B, Kaya FA, Dursun İ, Korkmaz L. Comparison of anesthesia management in transcatheter aortic valve implantation: a retrospective cohort study. Braz J Anesthesiol 2021; 72:629-636. [PMID: 34252453 PMCID: PMC9515671 DOI: 10.1016/j.bjane.2021.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 06/02/2021] [Accepted: 06/20/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We aimed to investigate the effects of two different anesthetic techniques in our patients who underwent transcatheter aortic valve implantation (TAVI). METHODS In this study, 303 patients who underwent TAVI procedure with a diagnosis of severe aortic stenosis between January 1, 2012 and December 31, 2018 were retrospectively evaluated. The patients were divided according to the type of anesthesia given during each procedure as; general anesthesia (GA), local anesthesia (LA). RESULTS LA was preferred in 245 (80.8%) of 303 patients who underwent TAVI, while GA was preferred in 58 patients (19.1%). Median ages of our patients who received LA and GA were 83 and 84, respectively. The procedure and anesthesia durations of the patients in the GA group were longer than the LA group (p< 0.00001, p < 0.00001, respectively). Demographic and pre-operative clinical data were similar in comparison between two groups (p > 0.05) except for peripheral artery disease. Hypertension was the most common comorbidity in both groups. While the number of inotrope use was significantly higher in patients who received GA (p < 0.00001), no significant differences were found between LA and GA patients in terms of major complications and mortality (p > 0.05). Intensive care and hospital stays were significantly shorter in the LA group (p = 0.001, p = 0.023, respectively). CONCLUSION The anesthetic technique of TAVI procedure did not have a significant effect on outcomes including; complications, mortality and success of the procedure. LA provides shorter duration of procedure and hospital stay.
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Affiliation(s)
- Gönül Erkan
- Health Sciences University, Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Anesthesiology and Reanimation, Trabzon, Turkey
| | - Buket Ozyaprak
- Health Sciences University, Bursa Yüksek Ihtisas Training and Research Hospital, Department of Anesthesiology and Reanimation, Bursa, Turkey
| | - Ferdane Aydoğdu Kaya
- Health Sciences University, Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Anesthesiology and Reanimation, Trabzon, Turkey
| | - İhsan Dursun
- Health Sciences University, Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Trabzon, Turkey.
| | - Levent Korkmaz
- Health Sciences University, Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Trabzon, Turkey
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11
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Feistritzer HJ, Kurz T, Stachel G, Hartung P, Lurz P, Eitel I, Marquetand C, Nef H, Doerr O, Vigelius-Rauch U, Lauten A, Landmesser U, Treskatsch S, Abdel-Wahab M, Sandri M, Holzhey D, Borger M, Ender J, Ince H, Öner A, Meyer-Saraei R, Hambrecht R, Wienbergen H, Fach A, Augenstein T, Frey N, König IR, Vonthein R, Funkat AK, Berggreen AE, Heringlake M, Desch S, de Waha-Thiele S, Thiele H. Impact of Anesthesia Strategy and Valve Type on Clinical Outcomes After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2021; 77:2204-2215. [PMID: 33926657 DOI: 10.1016/j.jacc.2021.03.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND The randomized SOLVE-TAVI (compariSon of secOnd-generation seLf-expandable vs. balloon-expandable Valves and gEneral vs. local anesthesia in Transcatheter Aortic Valve Implantation) trial compared newer-generation self-expanding valves (SEV) and balloon-expandable valves (BEV) as well as local anesthesia with conscious sedation (CS) and general anesthesia (GA) in patients undergoing transfemoral transcatheter aortic valve replacement (TAVR). Both strategies showed similar outcomes at 30 days. OBJECTIVES The purpose of this study was to compare clinical outcomes during 1-year follow-up in the randomized SOLVE-TAVI trial. METHODS Using a 2 × 2 factorial design 447 intermediate- to high-risk patients with severe, symptomatic aortic stenosis were randomly assigned to transfemoral TAVR using either the SEV (Evolut R, Medtronic Inc., Minneapolis, Minnesota) or the BEV (Sapien 3, Edwards Lifesciences, Irvine, California) as well as CS or GA at 7 sites. RESULTS In the valve-comparison strategy, rates of the combined endpoint of all-cause mortality, stroke, moderate or severe paravalvular leakage, and permanent pacemaker implantation were similar between the BEV and SEV group (n = 84, 38.3% vs. n = 87, 40.4%; hazard ratio: 0.94; 95% confidence interval: 0.70 to 1.26; p = 0.66) at 1 year. Regarding the anesthesia comparison, the combined endpoint of all-cause mortality, stroke, myocardial infarction, and acute kidney injury occurred with similar rates in the GA and CS groups (n = 61, 25.7% vs. n = 54, 23.8%; hazard ratio: 1.09; 95% confidence interval: 0.76 to 1.57; p = 0.63). CONCLUSIONS In intermediate- to high-risk patients undergoing transfemoral TAVR, newer-generation SEV and BEV as well as CS and GA showed similar clinical outcomes at 1 year using a combined clinical endpoint. (SecOnd-generation seLf-expandable Versus Balloon-expandable Valves and gEneral Versus Local Anesthesia in TAVI [SOLVE-TAVI]; NCT02737150).
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Affiliation(s)
- Hans-Josef Feistritzer
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany. https://twitter.com/feistritzerH_J
| | - Thomas Kurz
- University Clinic Schleswig-Holstein and University Heart Center Lübeck, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), Lübeck, Germany
| | - Georg Stachel
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany
| | - Philipp Hartung
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany
| | - Philipp Lurz
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany
| | - Ingo Eitel
- University Clinic Schleswig-Holstein and University Heart Center Lübeck, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), Lübeck, Germany
| | - Christoph Marquetand
- University Clinic Schleswig-Holstein and University Heart Center Lübeck, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), Lübeck, Germany
| | - Holger Nef
- Medizinische Klinik I, Abteilung für Kardiologie, Universitätsklinikum Marburg/Gießen, Gießen, Germany
| | - Oliver Doerr
- Medizinische Klinik I, Abteilung für Kardiologie, Universitätsklinikum Marburg/Gießen, Gießen, Germany
| | - Ursula Vigelius-Rauch
- Medizinische Klinik I, Abteilung für Kardiologie, Universitätsklinikum Marburg/Gießen, Gießen, Germany
| | - Alexander Lauten
- German Center for Cardiovascular Research (DZHK), Lübeck, Germany; Universitätsklinikum Charité, Campus Benjamin Franklin, Berlin, Germany
| | - Ulf Landmesser
- German Center for Cardiovascular Research (DZHK), Lübeck, Germany; Universitätsklinikum Charité, Campus Benjamin Franklin, Berlin, Germany
| | - Sascha Treskatsch
- Universitätsklinikum Charité, Campus Benjamin Franklin, Berlin, Germany
| | - Mohamed Abdel-Wahab
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany
| | - Marcus Sandri
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany
| | - David Holzhey
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany
| | - Michael Borger
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany
| | - Jörg Ender
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany
| | - Hüseyin Ince
- Medizinische Klinik I im Zentrum für Innere Medizin, Universitätsklinikum Rostock, Rostock, Germany
| | - Alper Öner
- Medizinische Klinik I im Zentrum für Innere Medizin, Universitätsklinikum Rostock, Rostock, Germany
| | - Roza Meyer-Saraei
- University Clinic Schleswig-Holstein and University Heart Center Lübeck, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), Lübeck, Germany
| | | | - Harm Wienbergen
- Klinikum Links der Weser, Herzzentrum Bremen, Bremen, Germany
| | - Andreas Fach
- Klinikum Links der Weser, Herzzentrum Bremen, Bremen, Germany
| | | | - Norbert Frey
- Department of Cardiology, Angiology and Pulmology, University Hospital Heidelberg, Heidelberg, Germany
| | - Inke R König
- German Center for Cardiovascular Research (DZHK), Lübeck, Germany; Institut für Medizinische Biometrie und Statistik, University of Lübeck, Lübeck, Germany
| | - Reinhard Vonthein
- Institut für Medizinische Biometrie und Statistik, University of Lübeck, Lübeck, Germany; Institut für Statistik, Ludwig-Maximilians-Universität München, Munich, Germany
| | | | - Astrid E Berggreen
- University Clinic Schleswig-Holstein and University Heart Center Lübeck, Lübeck, Germany
| | - Matthias Heringlake
- University Clinic Schleswig-Holstein and University Heart Center Lübeck, Lübeck, Germany
| | - Steffen Desch
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany; German Center for Cardiovascular Research (DZHK), Lübeck, Germany
| | - Suzanne de Waha-Thiele
- University Clinic Schleswig-Holstein and University Heart Center Lübeck, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), Lübeck, Germany
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany.
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12
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Trauzeddel RF, Nordine M, Balanika M, Bence J, Bouchez S, Ender J, Erb JM, Fassl J, Fletcher N, Mukherjee C, Prabhu M, van der Maaten J, Wouters P, Guarracino F, Treskatsch S. Current Anesthetic Care of Patients Undergoing Transcatheter Aortic Valve Replacement in Europe: Results of an Online Survey. J Cardiothorac Vasc Anesth 2020; 35:1737-1746. [PMID: 33036889 DOI: 10.1053/j.jvca.2020.09.088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Transcatheter aortic valve replacement (TAVR) has become an alternative treatment for patients with symptomatic aortic stenosis not eligible for surgical valve replacement due to a high periprocedural risk or comorbidities. However, there are several areas of debate concerning the pre-, intra- and post-procedural management. The standards and management for these topics may vary widely among different institutions and countries in Europe. DESIGN Structured web-based, anonymized, voluntary survey. SETTING Distribution of the survey via email among members of the European Association of Cardiothoracic Anaesthesiology working in European centers performing TAVR between September and December 2018. PARTICIPANTS Physicians. MEASUREMENTS AND MAIN RESULTS The survey consisted of 25 questions, including inquiries regarding number of TAVR procedures, technical aspects of TAVR, medical specialities present, preoperative evaluation of TAVR candidates, anesthesia regimen, as well as postoperative management. Seventy members participated in the survey. Reporting members mostly performed 151-to-300 TAVR procedures per year. In 90% of the responses, a cardiologist, cardiac surgeon, cardiothoracic anesthesiologist, and perfusionist always were available. Sixty-six percent of the members had a national curriculum for cardiothoracic anesthesia. Among 60% of responders, the decision for TAVR was made preoperatively by an interdisciplinary heart team with a cardiothoracic anesthesiologist, yet in 5 countries an anesthesiologist was not part of the decision-making. General anesthesia was employed in 40% of the responses, monitored anesthesia care in 44%, local anesthesia in 23%, and in 49% all techniques were offered to the patients. In cases of general anesthesia, endotracheal intubation almost always was performed (91%). It was stated that norepinephrine was the vasopressor of choice (63% of centers). Transesophageal echocardiography guiding, whether performed by an anesthesiologist or cardiologist, was used only ≤30%. Postprocedurally, patients were transferred to an intensive care unit by 51.43% of the respondents with a reported nurse-to-patient ratio of 1:2 or 1:3, to a post-anesthesia care unit by 27.14%, to a postoperative recovery room by 11.43%, and to a peripheral ward by 10%. CONCLUSION The results indicated that requirements and quality indicators (eg, periprocedural anesthetic management, involvement of the anesthesiologist in the heart team, etc) for TAVR procedures as published within the European guideline are largely, yet still not fully implemented in daily routine. In addition, anesthetic TAVR management also is performed heterogeneously throughout Europe.
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Affiliation(s)
- Ralf Felix Trauzeddel
- Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Michael Nordine
- Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Marina Balanika
- Department of Anesthesiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Johan Bence
- Department of Anaesthesia and Intensive Care, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Stefaan Bouchez
- Department of Anesthesiology and Perioperative Medicine, Ghent University, Gent, Belgium
| | - Jörg Ender
- Department of Anesthesiology and Intensive Care Medicine, Leipzig Heart Center, Leipzig, Germany
| | | | - Jens Fassl
- Institute of Cardiac Anesthesiology, University Heart Center Dresden, Dresden, Germany
| | - Nick Fletcher
- St Georges Hospital NHS Trust, London, United Kingdom; Cleveland Clinic, London, United Kingdom
| | - Chirojit Mukherjee
- Department of Anesthesiology and Intensive Care Medicine, HELIOS Heart Surgery Clinic Karlsruhe, Karlsruhe, Germany
| | - Mahesh Prabhu
- Cardiothoracic Anaesthesia and Intensive Care, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Joost van der Maaten
- Department of Anesthesiology, University Medical Center Groningen, Faculty of Medical Sciences, Groningen, The Netherlands
| | - Patrick Wouters
- Department of Anesthesiology and Perioperative Medicine, Ghent University, Gent, Belgium
| | - Fabio Guarracino
- Department of Anesthesiology and Critical Care Medicine, Azienda Ospedaliero-Universitatria Pisana, Pisa, Italy
| | - Sascha Treskatsch
- Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
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13
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Kronfli AP, Lehman E, Yamane K, Roberts SM, Cios TJ. Dexmedetomidine Is an Equal Cost Alternative to Propofol in Transcatheter Aortic Valve Replacement, With Equivalent In-Hospital and 30-Day Outcomes. J Cardiothorac Vasc Anesth 2020; 35:439-445. [PMID: 33004269 DOI: 10.1053/j.jvca.2020.08.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/16/2020] [Accepted: 08/17/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Transcatheter aortic valve replacement (TAVR) with monitored anesthesia care (MAC) is well-tolerated and is growing in popularity. Differences in outcomes based on anesthetic agent choice with MAC has received less attention. The authors sought to determine whether differences in outcomes and cost exist based on whether patients receive dexmedetomidine or propofol when undergoing TAVR with MAC. DESIGN Retrospective cohort study. SETTING The Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania. PARTICIPANTS The study comprised 161 patients who underwent TAVR with MAC between May 2014 and March 2019. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A propofol-only (n = 58) group and dexmedetomidine-only (n = 103) group were identified. No differences in in-hospital mortality or complication rate were identified when evaluating for stroke, transfusion, new arrhythmia, cardiac arrest, or bleeding and vascular complications (p > 0.05, all). Thirty-day outcomes were also equivalent, with no differences in mortality, stroke, vascular complication, new arrhythmia, or myocardial infarction (p > 0.05, all). The average amount of epinephrine, norepinephrine, or phenylephrine used intraoperatively was not significantly different. Overall median hospitalization costs were equivalent ($57,554.31 with dexmedetomidine v $58,538.08 with propofol, p = 0.97). CONCLUSIONS There were no significant differences in in-hospital outcomes, 30-day outcomes, or total cost of the patient's hospitalization, based on the use of dexmedetomidine versus propofol in patients undergoing TAVR.
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Affiliation(s)
- Anthony P Kronfli
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA.
| | - Erik Lehman
- Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA
| | - Kentaro Yamane
- Department of Surgery, Penn State Heart and Vascular Institute, The Pennsylvania State University College of Medicine, Hershey, PA
| | - S Michael Roberts
- Department of Anesthesiology, The Pennsylvania State University, College of Medicine, Hershey, PA
| | - Theodore J Cios
- Department of Anesthesiology, The Pennsylvania State University, College of Medicine, Hershey, PA
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14
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Neumann FJ, Redwood S, Abdel-Wahab M, Lefèvre T, Frank D, Eltchaninoff H, Caussin C, Stella PR, Hovorka T, Baumgartner H, Tarantini G, Wendler O, Treede H. General Anesthesia or Conscious Sedation for Transfemoral Aortic Valve Replacement with the SAPIEN 3 Transcatheter Heart Valve. Int Heart J 2020; 61:713-719. [PMID: 32684591 DOI: 10.1536/ihj.19-567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Differences in the benefits of conscious sedation (CS) and general anesthesia (GA) during transfemoral aortic valve implantation (TAVI) are unclear.We aimed to assess differences in procedural and clinical outcomes based on the type of anesthesia received during TAVI.We analyzed SOURCE 3 Registry data for patients who received the SAPIEN 3 valve by type of anesthesia used during TAVI.Of the 1694 TAVI patients, 1027 received CS and 667 received GA. Patients were similar at baseline (81.5 years; Society of Thoracic Surgeons risk score 7.0). Compared with the GA group, the CS group had fewer intra-procedural transesophageal echocardiography (TEE) and post implantation dilatations performed, and less contrast medium was used. The CS group had significantly less kidney injury at 7 days post-procedure than the GA group (0.4% versus 1.5%, P = 0.014). Moderate paravalvular leaks (PVL) occurred more frequently in the CS group versus the GA group (2.2% versus 0.8%; P = 0.041). No severe PVL were reported. Median total hospital length of stay (LOS) after TAVI was 10 days in the CS group and 11 days in the GS group. At 30 days, all-cause death was 2.1% in CS and 1.7% in GS (P = 0.47), and myocardial infarction was 0.2% in CS and 0.1% in GS (P = 0.83).Our analyses found no significant major outcome differences between CS and GA during TAVI.
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Affiliation(s)
| | | | | | - Thierry Lefèvre
- Institut Cardiovasculaire Paris Sud, Hopital privé Jacques Cartier
| | - Derk Frank
- University Hospital, Schleswig-Holstein, Kiel and DZHK (German Center for Cardiovascular Research, Kiel/Lübeck/Hamburg)
| | | | | | | | | | - Helmut Baumgartner
- Department of Cardiology III, University Hospital, Adult Congenital & Valvular Heart Disease
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15
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Cubeddu RJ, Sarkar A, Navas V, Navia JL. 'Minimalist approach' for transcatheter mitral valve replacement using intracardiac echocardiography and conscious sedation: a case series. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-5. [PMID: 32617475 PMCID: PMC7319820 DOI: 10.1093/ehjcr/ytaa058] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 10/10/2019] [Accepted: 02/06/2020] [Indexed: 11/29/2022]
Abstract
Background Transcatheter aortic valve implantation operators have adapted to a less invasive technique by foregoing the use of general anaesthesia and transoesophageal echocardiography. This is known as a ‘minimalist approach’. This approach has yet to be explored in transcatheter mitral valve replacement (TMVR). Two patients with high perioperative risk underwent TMVR using only monitored conscious sedation (CS) and intracardiac echocardiography (ICE). Case summary The patients were symptomatic and required treatment of severe mitral regurgitation and severe mitral stenosis in a mitral valve ring and prosthetic mitral valve, respectively. With the use of an antegrade transseptal approach, the procedure was conducted under CS using ICE only. After placement of the prosthetic mitral valve, the valve was assessed by advancing the ICE catheter through the interatrial septal defect and no significant paravalvular leak occurred. In one case, ad hoc treatment of right to left shunting was successfully pursued. Valve function was excellent immediately and at 24 h after implantation and resulted in significant haemodynamic improvement. Conclusion With more TMVR cases being conducted, the ‘minimalist approach’ with CS and ICE may be considered in selected cases.
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Affiliation(s)
- Robert J Cubeddu
- Department of Cardiology, Heart & Vascular Institute, Cleveland Clinic Florida, 2590 Cleveland Clinic Blvd, Weston, FL 33331, USA
| | - Abdullah Sarkar
- Department of Cardiology, Heart & Vascular Institute, Cleveland Clinic Florida, 2590 Cleveland Clinic Blvd, Weston, FL 33331, USA
| | - Viviana Navas
- Department of Cardiology, Heart & Vascular Institute, Cleveland Clinic Florida, 2590 Cleveland Clinic Blvd, Weston, FL 33331, USA
| | - Jose L Navia
- Department of Cardiology, Heart & Vascular Institute, Cleveland Clinic Florida, 2590 Cleveland Clinic Blvd, Weston, FL 33331, USA
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16
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Takahashi M, Mouillet G, Khaled A, Boukantar M, Gallet R, Rubimbura V, Lim P, Dubois-Rande JL, Teiger E. Perioperative Outcomes of Adjunctive Hypnotherapy Compared with Conscious Sedation Alone for Patients Undergoing Transfemoral Transcatheter Aortic Valve Implantation. Int Heart J 2020; 61:60-66. [DOI: 10.1536/ihj.19-296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Masao Takahashi
- Department of Cardiology, Henri Mondor University Hospital
- Department of Cardiovascular Medicine, Jichi Medical University School of Medicine
| | | | - Asmaa Khaled
- Department of Anesthesiology, Henri Mondor University Hospital
| | | | - Romain Gallet
- Department of Cardiology, Henri Mondor University Hospital
| | | | - Pascal Lim
- Department of Cardiology, Henri Mondor University Hospital
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Kislitsina ON, Smith D, Sherwani SS, Pham DT, Churyla A, Ricciardi MJ, Davidson CJ, Flaherty JD, Sweis RN, Kruse J, Andrei AC, McCarthy PM, Chris Malaisrie S. Comparison of Monitored Anesthesia Care and General Anesthesia for Transcatheter Aortic Valve Replacement. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 14:436-444. [DOI: 10.1177/1556984519872463] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective Transcatheter aortic valve replacement is a safe, minimally invasive treatment for severe aortic stenosis in patients with moderate-to-high surgical risk. Monitored anesthesia is administered by an anesthesiologist. This study compares transcatheter aortic valve outcomes under monitored anesthesia vs general anesthesia. Methods Data were prospectively collected for 286 patients undergoing transcatheter aortic valve replacement at a single academic hospital from March 2012 to August 2016. The patients were grouped by type of anesthesia: monitored vs general. A propensity score match was performed to compare intraoperative and post-operative outcomes between groups. Results General anesthesia was used in 102 patients and moderate sedation in 184. Propensity score matching produced 80 pairs. Compared to procedures under general anesthesia, patients receiving monitored anesthesia had shorter procedure (1.6 [1.4, 2.0] vs 2.0 [1.6, 2.5] hours; P < 0.001) and fluoroscopy times (17 [14.5, 22.5] vs 25 [17.9, 30.3] minutes; P < 0.001) and shorter hospital length-of-stay (3 [2.0, 4.0] vs 5 [3.0, 7.0] days; P < 0.001) but no difference in intensive care unit length-of-stay. Blood transfusion was more common in patients undergoing general anesthesia, but there was no difference in stroke, renal failure, postoperative atrial fibrillation, or need for permanent pacemaker. More patients were discharged to home after monitored anesthesia (90% vs 64%; P < 0.001). There was no difference in 30-day mortality (0% vs 3%; P = 0.15). Conclusions Transcatheter aortic valve replacement under monitored anesthesia provides the safety of anesthesia-led sedation without intubation and general anesthetic. We found no compromise in patient safety or clinical outcomes.
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Affiliation(s)
- Olga N. Kislitsina
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Cardiology, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Danielle Smith
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Saadia S. Sherwani
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Cardiology, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Duc Thinh Pham
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Andrei Churyla
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Mark J. Ricciardi
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Cardiology, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Charles J. Davidson
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Cardiology, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - James D. Flaherty
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Cardiology, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ranya N. Sweis
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Cardiology, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jane Kruse
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Adin-Chistian Andrei
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Patrick M. McCarthy
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - S. Chris Malaisrie
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Fischer Q, Urena M, Bouleti C, Abtan J, Brochet E, Carrasco JL, Iung B, Vahanian A, Himbert D. Performing optimal transcatheter aortic valve implantation: The need for tailored use of transcatheter valves. Arch Cardiovasc Dis 2019; 112:512-522. [PMID: 31474571 DOI: 10.1016/j.acvd.2019.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/01/2019] [Accepted: 05/23/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Despite the worldwide development of transcatheter aortic valve implantation (TAVI) over the last decade, strategies that take patient characteristics into account to guide the choice of transcatheter heart valve have not been evaluated. AIM To evaluate the immediate results of TAVI using a tailored choice of balloon-expandable or self-expanding transcatheter heart valve, according to each patient's clinical and anatomical characteristics. METHODS This single-centre observational study included all patients treated with TAVI from 2012 to 2017. The 30-day results were reported according to Valve Academic Research Consortium-2 criteria. A total of 502 patients were included (mean age, 81±9 years; 52% men; mean EuroSCORE II, 7.0±6.5%). Three main variables guided the choice of transcatheter heart valve: the anatomy of the iliofemoral arteries and of the aortic root, and the general condition of the patient. RESULTS A SAPIEN™ balloon-expandable transcatheter heart valve was used in 275 patients (55%) and a CoreValve™ self-expanding transcatheter heart valve in 227 patients (45%). The approach was transfemoral in 427 patients (85%), and only 29 patients (6%) required transthoracic access. At 30-day follow-up, the rates of adverse events were as follows: mortality, 3.2%; stroke, 3.0%; major bleeding, 5.9%; and major vascular complications, 6.0%. Rates of complications at 30 days were similar in the SAPIEN™ and CoreValve™ groups, except for a higher rate of pacemaker implantation in the latter group (29.5% vs. 14.5%; P<0.001). CONCLUSION The choice of balloon-expandable or self-expanding transcatheter heart valve tailored to the patient's clinical and anatomical characteristics allows for maximal use of the transfemoral approach, and is associated with low 30-day rates of major complications and mortality.
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Affiliation(s)
- Quentin Fischer
- Department of Cardiology, Bichat-Claude-Bernard Hospital, AP-HP, 75018 Paris, France; University Paris Diderot, 75013 Paris, France
| | - Marina Urena
- Department of Cardiology, Bichat-Claude-Bernard Hospital, AP-HP, 75018 Paris, France
| | - Claire Bouleti
- Department of Cardiology, Bichat-Claude-Bernard Hospital, AP-HP, 75018 Paris, France
| | - Jérémie Abtan
- Department of Cardiology, Bichat-Claude-Bernard Hospital, AP-HP, 75018 Paris, France
| | - Eric Brochet
- Department of Cardiology, Bichat-Claude-Bernard Hospital, AP-HP, 75018 Paris, France
| | - Jose-Luis Carrasco
- Department of Anaesthesiology, Bichat-Claude-Bernard Hospital, AP-HP, 75877 Paris, France
| | - Bernard Iung
- Department of Cardiology, Bichat-Claude-Bernard Hospital, AP-HP, 75018 Paris, France; Department of Anaesthesiology, Bichat-Claude-Bernard Hospital, AP-HP, 75877 Paris, France
| | - Alec Vahanian
- Department of Cardiology, Bichat-Claude-Bernard Hospital, AP-HP, 75018 Paris, France; University Paris Diderot, 75013 Paris, France
| | - Dominique Himbert
- Department of Cardiology, Bichat-Claude-Bernard Hospital, AP-HP, 75018 Paris, France.
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19
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Alcici ME, Lodi-Junqueira L, Sant'Anna Athayde GR, Soares JR, Gomes Tiago DA, Tavares PL, Saad GP, Ferreira de Sales I, Okello E, Rwebembera J, Esteves WAM, Nunes MCP. The Importance of Conscious Sedation for Life-Saving Valve Procedures in Patients With Rheumatic Heart Disease From Low- to Middle-Income Countries. Glob Heart 2019; 14:311-316. [PMID: 31451239 DOI: 10.1016/j.gheart.2019.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 06/27/2019] [Accepted: 07/03/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Severe valve disease, which requires intervention, remains strongly associated with mortality in patients with rheumatic heart disease. Percutaneous mitral commissurotomy (PMC) is the procedure of choice for the treatment of patients with isolated or predominantly rheumatic mitral stenosis. This procedure has been performed under sedation to avoid the potential effects of general anesthesia on intracardiac pressure measurements. However, there are limited data on sedation during PMC, especially using easily available medications in low- and middle-income countries. OBJECTIVES This study was designed to evaluate the efficacy and hemodynamic effects of conscious sedation during PMC in patients with significant mitral stenosis. METHODS This study prospectively enrolled 23 patients who underwent PMC with the Inoue balloon technique for hemodynamically significant mitral stenosis. For conscious sedation, midazolam 25 μg/kg and fentanyl 1 μg/kg were administered, and 5 min after the infusion, the level of sedation was evaluated by Ramsay sedation scale. A range of invasive hemodynamic measurements, including cardiac output and pulmonary artery pressures, were recorded before and immediately after sedation. RESULTS The mean age was 44.9 ± 10.8 years, and 19 patients (83%) were women. After sedation, the majority of patients were in categories 2 and 3 of the Ramsay sedation scale (cooperative, orientated, tranquil, and responding to commands). Oxygen saturation dropped from an average of 98.5% to 96.0% without supplementary oxygen. Left ventricular systolic pressure and central aortic pressures decreased after sedation. However, none of the other parameters changed significantly after sedation, including pulmonary artery pressures, pulmonary vascular resistance, and cardiac index. CONCLUSIONS This simple model of conscious sedation was able to promote anxiolysis, analgesia, and comfort for the procedure without serious hemodynamic effects, which can be a reasonable choice in developing countries.
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Affiliation(s)
- Marta Eugenia Alcici
- Hospital das Clínicas, School of Medicine, Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Lucas Lodi-Junqueira
- Hospital das Clínicas, School of Medicine, Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Guilherme Rafael Sant'Anna Athayde
- Hospital das Clínicas, School of Medicine, Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Juliana Rodrigues Soares
- Hospital das Clínicas, School of Medicine, Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Diogo Antônio Gomes Tiago
- Hospital das Clínicas, School of Medicine, Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Priscila Lima Tavares
- Hospital das Clínicas, School of Medicine, Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Gabriel Prado Saad
- Hospital das Clínicas, School of Medicine, Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Igor Ferreira de Sales
- Hospital das Clínicas, School of Medicine, Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Emmy Okello
- Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | | | - William A M Esteves
- Hospital das Clínicas, School of Medicine, Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Maria Carmo P Nunes
- Hospital das Clínicas, School of Medicine, Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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20
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Tanner R, Moran B, Margey R, Blake G, McGorrian C, Geraghty J, Groarke S, Boleckova J, Hurley J, Roy A, Barton D, Sugrue D, Casserly IP. Clinical experience with trans-catheter aortic valve implantation at a tertiary hospital in the Republic of Ireland. Ir J Med Sci 2019; 189:139-148. [PMID: 31197575 DOI: 10.1007/s11845-019-02030-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 04/30/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION There is a paucity of published data on the clinical experience with trans-catheter aortic valve implantation (TAVI) in the Republic of Ireland. We sought to examine the clinical outcomes of patients with medium-term follow-up treated with TAVI at our institution. METHODS A prospective TAVI registry was used to assess the baseline demographics, procedural variables and clinical outcomes of patients treated with TAVI between the inception of the programme in 2008 and November 2017. RESULTS A total of 354 patients (mean age 80.9 ± 8.1 years, 58% male, mean STS score 6.1 ± 4.3%) were treated during the study period. Major in-hospital outcomes included in-lab death (n = 2, 0.6%), stroke (n = 8, 2.2%), device embolisation (n = 4, 1.2%), permanent pacemaker implantation (n = 22, 6.2%) and major vascular complication (n = 2, 0.6%). The median length of hospital stay was 4 days (IQR 2-8 days). The Kaplan-Meier estimate of freedom from death at 30 days and 1 year for the entire cohort was 97 ± 1% and 85.4 ± 2.3%, respectively. Trans-femoral access was associated with a significantly lower rate of death and/or stroke at 1 year compared to trans-apical access (84.9 ± 2.4% versus 60 ± 8.9%, p = 0.0005). There was no significant difference in freedom from death and/or stroke at 1 year between balloon-expandable and self-expanding valves (81.6 ± 2.6% versus 84.4 ± 7.4%, p = 0.63). CONCLUSION This study documents low complication rates and favourable rates of survival following TAVI in a consecutive series of patients undergoing TAVI at a tertiary referral centre in the Republic of Ireland. These data support the application of this therapy in the Irish context.
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Affiliation(s)
- Richard Tanner
- Department of Cardiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.
| | - Barbara Moran
- Mater Private Hospital, Eccles Street, Dublin 7, Ireland
| | - Ronan Margey
- Mater Private Hospital, Eccles Street, Dublin 7, Ireland
| | - Gavin Blake
- Department of Cardiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Catherine McGorrian
- Department of Cardiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Jacqueline Geraghty
- Department of Cardiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Susan Groarke
- Department of Cardiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | | | - John Hurley
- Mater Private Hospital, Eccles Street, Dublin 7, Ireland
| | - Andrew Roy
- Mater Private Hospital, Eccles Street, Dublin 7, Ireland
| | - David Barton
- Mater Private Hospital, Eccles Street, Dublin 7, Ireland
| | - Declan Sugrue
- Mater Private Hospital, Eccles Street, Dublin 7, Ireland
| | - Ivan P Casserly
- Department of Cardiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.,Mater Private Hospital, Eccles Street, Dublin 7, Ireland
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21
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Stella S, Melillo F, Capogrosso C, Fisicaro A, Ancona F, Latib A, Montorfano M, Colombo A, Alfieri O, Castiglioni A, Margonato A, Agricola E. Intra-procedural monitoring protocol using routine transthoracic echocardiography with backup trans-oesophageal probe in transcatheter aortic valve replacement: a single centre experience. Eur Heart J Cardiovasc Imaging 2019; 21:85-92. [DOI: 10.1093/ehjci/jez066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 03/25/2019] [Accepted: 03/25/2019] [Indexed: 01/10/2023] Open
Abstract
Abstract
Aim
The aim of this study is to describe our 9-year experience in transcatheter aortic valve replacement (TAVR) using transthoracic echocardiography (TTE) as a routine intra-procedural imaging modality with trans-oesophageal echocardiography (TEE) as a backup.
Methods and results
From January 2008 to December 2017, 1218 patients underwent transfemoral TAVR at our Institution. Except the first 20 cases, all procedures have been performed under conscious sedation, with fluoroscopic guidance and TTE imaging monitoring. Once the TTE resulted suboptimal for final result assessment or a complication was either suspected or identified on TTE, TEE evaluation was promptly performed under general anaesthesia. Only 24 (1.9%) cases required a switch to TEE: 6 cases for suboptimal TTE prosthetic valve leak (PVL) quantification; 12 cases for haemodynamic instability; 2 cases for pericardial effusion without haemodynamic instability; 4 cases for urgent TAVR. The 30-days and 1-year all-cause mortality were 2.1% and 10.2%, respectively. Cardiac mortality at 30-days and 1-year follow-up were 0.6% and 4.1%, respectively. Intra-procedural and pre-discharge TT evaluation showed good agreement for PVL quantification (k agreement: 0.827, P = 0.005).
Conclusion
TTE monitoring seems a reasonable imaging tool for TAVR intra-procedural monitoring without delay in diagnosis of complications and a reliable paravalvular leak assessment. However, TEE is undoubtedly essential in identifying the exact mechanism in most of the complications.
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Affiliation(s)
- S Stella
- Echocardiography Unit, Cardio-Thoracic Department, San Raffaele Hospital, IRCCS, Milano, Italy
| | - F Melillo
- Echocardiography Unit, Cardio-Thoracic Department, San Raffaele Hospital, IRCCS, Milano, Italy
| | - C Capogrosso
- Echocardiography Unit, Cardio-Thoracic Department, San Raffaele Hospital, IRCCS, Milano, Italy
| | - A Fisicaro
- Echocardiography Unit, Cardio-Thoracic Department, San Raffaele Hospital, IRCCS, Milano, Italy
| | - F Ancona
- Echocardiography Unit, Cardio-Thoracic Department, San Raffaele Hospital, IRCCS, Milano, Italy
| | - A Latib
- Interventional Cariology Unit, Cardio-Thoracic Department, San Raffaele Hospital, IRCCS, Milano, Italy
| | - M Montorfano
- Interventional Cariology Unit, Cardio-Thoracic Department, San Raffaele Hospital, IRCCS, Milano, Italy
| | - A Colombo
- Interventional Cariology Unit, Cardio-Thoracic Department, San Raffaele Hospital, IRCCS, Milano, Italy
| | - O Alfieri
- Cardiac Surgery Unit, Cardio-Thoracic Department, San Raffaele Hospital, IRCCS, Milano, Italy
| | - A Castiglioni
- Cardiac Surgery Unit, Cardio-Thoracic Department, San Raffaele Hospital, IRCCS, Milano, Italy
| | - A Margonato
- Echocardiography Unit, Cardio-Thoracic Department, San Raffaele Hospital, IRCCS, Milano, Italy
| | - E Agricola
- Echocardiography Unit, Cardio-Thoracic Department, San Raffaele Hospital, IRCCS, Milano, Italy
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Wood DA, Lauck SB, Cairns JA, Humphries KH, Cook R, Welsh R, Leipsic J, Genereux P, Moss R, Jue J, Blanke P, Cheung A, Ye J, Dvir D, Umedaly H, Klein R, Rondi K, Poulter R, Stub D, Barbanti M, Fahmy P, Htun N, Murdoch D, Prakash R, Barker M, Nickel K, Thakkar J, Sathananthan J, Tyrell B, Al-Qoofi F, Velianou JL, Natarajan MK, Wijeysundera HC, Radhakrishnan S, Horlick E, Osten M, Buller C, Peterson M, Asgar A, Palisaitis D, Masson JB, Kodali S, Nazif T, Thourani V, Babaliaros VC, Cohen DJ, Park JE, Leon MB, Webb JG. The Vancouver 3M (Multidisciplinary, Multimodality, But Minimalist) Clinical Pathway Facilitates Safe Next-Day Discharge Home at Low-, Medium-, and High-Volume Transfemoral Transcatheter Aortic Valve Replacement Centers. JACC Cardiovasc Interv 2019; 12:459-469. [DOI: 10.1016/j.jcin.2018.12.020] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 12/12/2018] [Accepted: 12/18/2018] [Indexed: 10/27/2022]
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23
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Attizzani GF, Patel SM, Dangas GD, Szeto WY, Sorajja P, Reardon MJ, Popma JJ, Kodali S, Chenoweth S, Costa MA. Comparison of Local Versus General Anesthesia Following Transfemoral Transcatheter Self-Expanding Aortic Valve Implantation (from the Transcatheter Valve Therapeutics Registry). Am J Cardiol 2019; 123:419-425. [PMID: 30527797 DOI: 10.1016/j.amjcard.2018.10.041] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 10/24/2018] [Accepted: 10/25/2018] [Indexed: 10/27/2022]
Abstract
Transfemoral transcatheter aortic valve replacement (TF-TAVR) is mostly performed under general anesthesia (GA) in most US centers. We examined in-hospital and 30-day outcomes in patients who underwent TF-TAVR with a self-expanding bioprosthesis using local anesthesia (LA) or GA. Patients from the Transcatheter Valve Therapeutics Registry who underwent TF-TAVR from January 2014 to June 2016 with LA or GA were evaluated. Propensity matching was performed and procedural and clinical outcomes compared up to 30 days. A total of 11,006 patients were included (GA: 8,239 [74.9%] and LA: 2,767 [25.1%]). After propensity matching (n = 1,988 matched sets), device success was similar (94.5% vs 94.6%, p = 0.905). No differences in in-hospital stroke (2.7% vs 2.3%, p = 0.413) or paravalvular regurgitation grade (p = 0.113) were noted. Fewer LA patients were converted to open heart surgery (0.2% vs 0.6%, p = 0.076) or experienced an in-hospital major vascular complication (0.7% vs 1.4%, p = 0.026). Intensive care unit time (40.1 ± 58.4 vs 50.9 ± 72.1 hours, p < 0.001) and postprocedure length of stay (4.1 ± 3.6 vs 5.0 ± 4.5 days, p < 0.001) were significantly shorter with LA. In-hospital and 30-day all-cause mortality were lower in the LA cohort compared to the GA cohort ([1.1% vs 2.7%, p < 0.001] and [2.1% vs 3.9%, p = 0.001]). In conclusion, in the largest series of self-expanding bioprostheses for TF-TAVR, these propensity-matched cohorts demonstrate that LA is an acceptable alternative to GA with comparable success, lower safety outcomes, complications rates, and in-hospital and 30-day all-cause mortality.
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24
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Burns MR, Schneider LM, Sorajja P, Garberich RF, Rush PS, Foag K, Strauss CE, Perry T, Sweeney Claussen A, Farivar RS, Gössl M. Clinical and Economic Outcomes of the Minimalist Approach for Transcatheter Aortic Valve Replacement. STRUCTURAL HEART 2019. [DOI: 10.1080/24748706.2018.1560520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Marcus R. Burns
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Lynelle M. Schneider
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Ross F. Garberich
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Pamela S. Rush
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Katie Foag
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Craig E. Strauss
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Tjorvi Perry
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Andrea Sweeney Claussen
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - R. Said Farivar
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Mario Gössl
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
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25
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Renner J, Tesdorpf A, Freitag‐Wolf S, Francksen H, Petzina R, Lutter G, Frey N, Frank D. A retrospective study of conscious sedation versus general anaesthesia in patients scheduled for transfemoral aortic valve implantation: A single center experience. Health Sci Rep 2019; 2:e95. [PMID: 30697594 PMCID: PMC6346987 DOI: 10.1002/hsr2.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 09/04/2018] [Accepted: 09/17/2018] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES The current 2017 ESC/EACTS guidelines recommend transcatheter aortic valve implantations (TAVIs) as the therapy of choice for inoperable patients with severe symptomatic aortic stenosis. Most of the TAVIs worldwide are performed under general anaesthesia (GA). Although conscious sedation (CS) concepts are increasingly applied in Europe, it is still a matter of debate which concept is associated with highest amount of safety for this high-risk patient population. The aim of this single center, before-and-after study was to investigate feasibility and safety of CS compared with GA with respect to peri-procedural complications and 30-day mortality in patients scheduled for transfemoral TAVI (TF-TAVI). METHODS From March 2012 until September 2014, patients scheduled for the TF-TAVI procedure were included in a prospective, observational manner. From the 200 patients finally included, 107 procedures were performed under GA, using either an endotracheal tube or a laryngeal mask, and balanced anaesthesia. CS was performed in 93 patients using low-dose propofol and remifentanil. RESULTS Conversion to GA was needed 4 times due to procedural-related complications (4.3%), in one patient due to ongoing agitation (1.1%). The CS-group showed significantly shorter key time courses: anaesthesia time (105 [95-120] minutes vs 115 [105-140] minutes, P-value = 0.009, Mann-Whitney-U-test) and length of stay in the intensive care unit (1.6 [1.0-1.5] d vs 2.1 [1.0-2.0] d, P-value = 0.002, Mann-Whitney-U-test). The lowest mean arterial pressure was significantly higher in the CS-group compared with the GA-group (74.3 mmHg vs 55.2 mmHg, P-value <0.0001, t-test). CS was associated with less requirements of norepinephrine (0.1 μg/kg vs 2.3 μg/kg, P-value <0.0001, Mann-Whitney-U-test). CONCLUSIONS Our single-center data demonstrate that CS is a feasible and safe alternative, especially with respect to a higher degree of intra-procedural haemodynamic stability, and a reduced length of stay in the intensive care unit.
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Affiliation(s)
- Jochen Renner
- Department of Anaesthesiology and Intensive Care MedicineUniversity Hospital Schleswig‐HolsteinGermany
| | - Anna Tesdorpf
- Department of Trauma SurgeryUniversity Hospital Schleswig‐HolsteinGermany
| | | | - Helga Francksen
- Department of Anaesthesiology and Intensive Care MedicineUniversity Hospital Schleswig‐HolsteinGermany
| | - Rainer Petzina
- Department for Cardiovascular SurgeryUniversity Hospital Schleswig‐HolsteinGermany
| | - Georg Lutter
- Department for Cardiovascular SurgeryUniversity Hospital Schleswig‐HolsteinGermany
| | - Norbert Frey
- Department of Cardiology and AngiologyUniversity Hospital Schleswig‐HolsteinGermany
| | - Derk Frank
- Department of Cardiology and AngiologyUniversity Hospital Schleswig‐HolsteinGermany
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26
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Kinno M, Cantey EP, Rigolin VH. The transition from transesophageal to transthoracic echocardiography during transcatheter aortic valve replacement: an evolving field. J Echocardiogr 2018; 17:25-34. [DOI: 10.1007/s12574-018-0409-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 11/07/2018] [Indexed: 11/25/2022]
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27
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Sato K, Jones PM. Sedation versus general anesthesia for transcatheter aortic valve replacement. J Thorac Dis 2018; 10:S3588-S3594. [PMID: 30505539 DOI: 10.21037/jtd.2018.08.89] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
There is currently significant controversy regarding the best anesthesia management for patients undergoing transcatheter aortic valve replacement (TAVR). Some institutions primarily use general anesthesia (GA) but many institutions primarily use moderate sedation. Much of the controversy is due to the limited evidence base available to inform this decision and the strong feelings and pre-conceived notions about the optimal anesthesia technique which exist amongst anesthesiologists, cardiologists, and cardiac surgeons. In this article and in the context of TAVR, we will define the salient differences between GA and sedation, review the results and limitations of the currently available data, and discuss the priority questions for future research.
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Affiliation(s)
- Keita Sato
- Department of Anesthesia & Perioperative Medicine, University of Western Ontario, London, ON, Canada
| | - Philip M Jones
- Department of Anesthesia & Perioperative Medicine, University of Western Ontario, London, ON, Canada.,Department of Epidemiology & Biostatistics, University of Western Ontario, London, ON, Canada
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28
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Transcatheter Valve Procedures and the Anesthesiologist. Int Anesthesiol Clin 2018; 56:74-97. [PMID: 30204609 DOI: 10.1097/aia.0000000000000208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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29
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Yagasaki H, Goto Y, Mori Y, Noda T. Transcatheter aortic valve replacement with intracardiac echocardiography from the right internal jugular vein. Cardiovasc Diagn Ther 2018; 8:525-529. [PMID: 30214870 DOI: 10.21037/cdt.2018.07.06] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Transesophageal echocardiography (TEE) is a useful imaging modality to guide transcatheter aortic valve replacement (TAVR). The limitations of TEE include the need for general anesthesia (GA) and endotracheal intubation. In Europe, TAVR under local anesthesia (LA) is usually performed without TEE. An intracardiac echocardiography (ICE) catheter may be used as an alternative to TEE, but the catheter is usually inserted from the femoral vein (FV-ICE). There are some reports of TAVR with FV-ICE; however, there are no reports of ICE inserted from the right internal jugular vein (JV-ICE). In the first case of its kind, we successfully performed TAVR under LA with JV-ICE. JV-ICE allows for the evaluation of perioperative hemodynamics, measurement of the aortic valve complex, and assessment of major complications during the procedure without interference from the operator or fluoroscopes; these represent a distinct advantage over TEE, transthoracic echocardiography, and FV-ICE. Moreover, there is no need for the echocardiologist to use maximal barrier precautions; the catheter can be operated in the standing position, like TEE; and operability is higher than that with FV-ICE. TAVR with JV-ICE is a promising alternative to TAVR under GA with TEE and TAVR under LA with FV-ICE.
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Affiliation(s)
- Hiroto Yagasaki
- Department of Cardiology, Gifu Prefectural General Medical Center, Gifu City, Gifu, Japan
| | - Yoshiaki Goto
- Department of Cardiology, Gifu Prefectural General Medical Center, Gifu City, Gifu, Japan
| | - Yoshio Mori
- Department of Cardiovascular Surgery, Gifu Prefectural General Medical Center, Gifu City, Gifu, Japan
| | - Toshiyuki Noda
- Department of Cardiology, Gifu Prefectural General Medical Center, Gifu City, Gifu, Japan
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30
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Goins AE, Smeltz A, Ramm C, Strassle PD, Teeter EG, Vavalle JP, Kolarczyk L. General Anesthesia for Transcatheter Aortic Valve Replacement: Total Intravenous Anesthesia is Associated with Less Delirium as Compared to Volatile Agent Technique. J Cardiothorac Vasc Anesth 2018; 32:1570-1577. [DOI: 10.1053/j.jvca.2017.12.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Indexed: 12/20/2022]
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31
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Akodad M, Lefèvre T. TAVI: Simplification Is the Ultimate Sophistication. Front Cardiovasc Med 2018; 5:96. [PMID: 30087900 PMCID: PMC6066956 DOI: 10.3389/fcvm.2018.00096] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 06/29/2018] [Indexed: 12/19/2022] Open
Abstract
Since its introduction in 2002, TAVI has evolved dramatically and is now standard of care for intermediate risk patients when the femoral approach can be implemented safely. The development of innovative transcatheter heart valves (THVs) and refinement of technical skills have contributed to the decrease in complication rates associated with TAVI4. Increased experience, smaller sheaths, rigorous pre-procedural planning and improved vascular closing techniques have resulted in markedly lower rates of vascular complications. The next step is the simplification of the procedure, which should contribute to a further decrease in complications, and also reduce procedural time, hospital stay as well as staff workload and costs. Moving to conscious sedation, no predilatation, no temporary pace maker and use of the radial approach as the contralateral approach are all instrumental in achieving this ultimate refinement.
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Affiliation(s)
- Mariama Akodad
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France.,Centre Hospitalier Universitaire Arnaud de Villeneuve, Montpellier, France
| | - Thierry Lefèvre
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France
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32
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Sherifi I, Omar AMS, Varghese M, Weiner M, Anyanwu A, Kovacic JC, Sharma S, Kini A, Sengupta PP. Comparison of transesophageal and transthoracic echocardiography under moderate sedation for guiding transcatheter aortic valve replacement. Echo Res Pract 2018; 5:79-87. [PMID: 29743180 PMCID: PMC5987181 DOI: 10.1530/erp-17-0080] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 05/09/2018] [Indexed: 11/10/2022] Open
Abstract
The optimal periprocedural imaging strategy during transcathether aortic valve replacement (TAVR) performed under moderate sedation is debated. Transthoracic echocardiography (TTE) provides suboptimal views due to poorer resolution and patient positioning, whereas use of transesophageal echocardiography (TEE) under moderate sedation is not widely utilized. The aim of our study was to compare the value of TTE in comparison with TEE guidance under moderate sedation during TAVR. The study population included 144 consecutive patients (mean age 83 ± 11 years, 78 (54%) females) who had TAVR under moderate sedation using either a TTE (n = 96) or TEE (n = 48). We compared procedural outcomes using propensity score matching. There were no significant inter-group differences in age, sex, ejection fraction, aortic valve area, pressure gradients, creatinine or type of valve used. The procedural time was significantly shorter in the TEE group (P < 0.001) and associated with a lower need for periprocedural aortograms (7.7 ± 1.9 vs 8.2 ± 1.9, P = 0.022) and a lower occurrence of acute kidney injury (1 vs 11, P = 0.047). The 1:1 propensity score matching also showed a lower procedural time (P = 0.032), number of aortograms (P = 0.014) and a trend toward lower acute kidney injury in the TEE group (P = 0.077). TAVR guidance using TEE is associated with a lower fluoroscopic time, a lower need for additional aortograms and trend in lower occurrence of post-TAVR acute kidney injury.
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Affiliation(s)
- Ines Sherifi
- Division of Cardiology, Weill Cornell Medical Center, New York, New York, USA.,Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alaa Mabrouk Salem Omar
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Internal Medicine, Bronx Lebanon Hospital Center, New York, New York, USA.,Department of Internal Medicine, Medical Division, National Research Center, Cairo, Egypt
| | - Mithun Varghese
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Menachem Weiner
- Division of Anesthesia, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ani Anyanwu
- Division of Cardiothoracic Surgery, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jason C Kovacic
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samin Sharma
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Annapoorna Kini
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Partho P Sengupta
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York, USA .,WVU Heart & Vascular Institute, University of West Virginia, Morgantown, West Virginia, USA
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Neuburger PJ, Patel PA, Williams MR. Anesthetic Technique for TAVR: More Than Just “Tube” or “No Tube”. J Cardiothorac Vasc Anesth 2018; 32:672-674. [DOI: 10.1053/j.jvca.2017.08.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Indexed: 11/11/2022]
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Kimmel J, Potosky R, Williams MR, Glading M, Neuburger PJ, Roberts JD, Feider A. Conversion from Monitored Anesthesia Care to General Anesthesia for Transcatheter Aortic Valve Replacement. J Cardiothorac Vasc Anesth 2018; 32:1032-1040. [DOI: 10.1053/j.jvca.2017.05.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Indexed: 11/11/2022]
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Maldonado Y, Baisden J, Villablanca PA, Weiner MM, Ramakrishna H. General Anesthesia Versus Conscious Sedation for Transcatheter Aortic Valve Replacement—An Analysis of Current Outcome Data. J Cardiothorac Vasc Anesth 2018; 32:1081-1086. [DOI: 10.1053/j.jvca.2017.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Indexed: 11/11/2022]
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Husser O, Fujita B, Hengstenberg C, Frerker C, Beckmann A, Möllmann H, Walther T, Bekeredjian R, Böhm M, Pellegrini C, Bleiziffer S, Lange R, Mohr F, Hamm CW, Bauer T, Ensminger S. Conscious Sedation Versus General Anesthesia in Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2018; 11:567-578. [DOI: 10.1016/j.jcin.2017.12.019] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/14/2017] [Accepted: 12/19/2017] [Indexed: 12/23/2022]
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Gallego-Ligorit L, Vives M, Vallés-Torres J, Sanjuán-Villarreal TA, Pajares A, Iglesias M. Use of Dexmedetomidine in Cardiothoracic and Vascular Anesthesia. J Cardiothorac Vasc Anesth 2017; 32:1426-1438. [PMID: 29325842 DOI: 10.1053/j.jvca.2017.11.044] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Indexed: 12/16/2022]
Abstract
Dexmedetomidine is a highly selective α2-adrenergic agonist with analgesic and sedative properties. In the United States, the Food and Drug Administration approved the use of the drug for short-lasting sedation (24 h) in intensive care units (ICUs) in patients undergoing mechanical ventilation and endotracheal intubation. In October 2008, the Food and Drug Administration extended use of the drug for the sedation of nonintubated patients before and during surgical and nonsurgical procedures. In the European Union, the European Medicine Agency approved the use of dexmedetomidine in September 2011 with a single recognized indication: ICU adult patients requiring mild sedation and awakening in response to verbal stimulus. At present, the use of dexmedetomidine for sedation outside the ICU remains an off-label indication. The benefits of dexmedetomidine in critically ill patients and in cardiac, electrophysiology-related, vascular, and thoracic procedures are discussed.
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Affiliation(s)
- Lucía Gallego-Ligorit
- Department of Anesthesiology and Critical Care Medicine, Cardiovascular and Thoracic Anesthesia Section,Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | - Marc Vives
- Department of Anesthesiology and Critical Care Medicine, Hospital de Bellvitge, Barcelona, Spain
| | - Jorge Vallés-Torres
- Department of Anesthesiology and Critical Care Medicine, Cardiovascular and Thoracic Anesthesia Section,Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - T Alberto Sanjuán-Villarreal
- Department of Anesthesiology and Critical Care Medicine, Cardiovascular and Thoracic Anesthesia Section,Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Azucena Pajares
- Department of Anesthesiology and Critical Care Medicine, Cardiovascular and Thoracic Anesthesia Section,Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | - Mario Iglesias
- Department of Anesthesiology and Reanimation, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón. (IiSGM), Madrid, Spain
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Neuburger PJ, Patel PA. Anesthetic Techniques in Transcatheter Aortic Valve Replacement and the Evolving Role of the Anesthesiologist. J Cardiothorac Vasc Anesth 2017; 31:2175-2182. [DOI: 10.1053/j.jvca.2017.03.033] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Indexed: 11/11/2022]
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Hosoba S, Yamamoto M, Shioda K, Sago M, Koyama Y, Shimura T, Kagase A, Tada N, Naganuma T, Araki M, Yamanaka F, Shirai S, Watanabe Y, Hayashida K. Safety and efficacy of minimalist approach in transfemoral transcatheter aortic valve replacement: insights from the Optimized transCathEter vAlvular interventioN–Transcatheter Aortic Valve Implantation (OCEAN-TAVI) registry†. Interact Cardiovasc Thorac Surg 2017; 26:420-424. [DOI: 10.1093/icvts/ivx355] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 10/03/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Soh Hosoba
- Department of cardiovascular surgery, Toyohashi Heart Center, Toyohashi, Japan
| | | | - Kayoko Shioda
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Mitsuru Sago
- Department of cardiovascular surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Yutaka Koyama
- Department of cardiovascular surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Tetsuro Shimura
- Department of cardiology, Toyohashi Heart Center, Toyohashi, Japan
| | - Ai Kagase
- Department of cardiology, Toyohashi Heart Center, Toyohashi, Japan
| | - Norio Tada
- Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Motoharu Araki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Futoshi Yamanaka
- Department of Cardiology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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40
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Xu B, Mottram PM, Lockwood S, Meredith IT. Imaging Guidance for Transcatheter Aortic Valve Replacement: Is Transoesophageal Echocardiography the Gold Standard? Heart Lung Circ 2017; 26:1036-1050. [DOI: 10.1016/j.hlc.2017.02.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 11/16/2016] [Accepted: 02/15/2017] [Indexed: 12/21/2022]
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41
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Ehret C, Rossaint R, Foldenauer AC, Stoppe C, Stevanovic A, Dohms K, Hein M, Schälte G. Is local anaesthesia a favourable approach for transcatheter aortic valve implantation? A systematic review and meta-analysis comparing local and general anaesthesia. BMJ Open 2017; 7:e016321. [PMID: 28951409 PMCID: PMC5623571 DOI: 10.1136/bmjopen-2017-016321] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 07/29/2017] [Accepted: 08/23/2017] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES We conducted a systematic review and meta-analysis to identify the potential favourable effects of local anaesthesia plus sedation (LAS) compared with general anaesthesia (GA) in transcatheter aortic valve implantation (TAVI). METHODS Electronic databases (PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials) and the reference lists of eligible publications were screened for randomised controlled trials (RCTs) and observational studies published between 1 January 2006 and 26 June 2016 that compare LAS to GA in an adult study population undergoing TAVI. We conducted study quality assessments using the Cochrane risk of bias tool and structured the review according to PRISMA. A meta-analysis calculating the pooled risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) under the assumption of a random-effects model was performed. Statistical heterogeneity was evaluated using the I² statistic and Cochran's Q-test. RESULTS After database screening, one RCT and 19 observational studies were included in the review. We found no differences between LAS and GA in terms of 30-day mortality, in-hospital mortality and other endpoints that addressed safety and complication rates. LAS was associated with a shorter ICU and hospital stay and with lower rates of catecholamine administration and red blood cell transfusion. New pacemaker implantations occurred more frequently under LAS. The overall conversion rate from LAS to GA was 6.2%. CONCLUSION For TAVI, both LAS and GA are feasible and safe. LAS may have some benefits such as increased haemodynamic stability and shorter hospital and ICU stays, but it does not impact 30-day mortality. Since there is a paucity of randomised trial data and the findings are mainly based on observational study data, this review should be considered as a hypothesis-generating article for subsequent RCTs that are required to confirm the potential favourable effects we detected for LAS. REGISTRATION NUMBER CRD42016048398 (PROSPERO).
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Affiliation(s)
- Constanze Ehret
- Department of Anaesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Rolf Rossaint
- Department of Anaesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | | | - Christian Stoppe
- Department of Anaesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Ana Stevanovic
- Department of Anaesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Katharina Dohms
- Department of Anaesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Marc Hein
- Department of Anaesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Gereon Schälte
- Department of Anaesthesiology, University Hospital RWTH Aachen, Aachen, Germany
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42
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Young MN, Inglessis I. Transcatheter Aortic Valve Replacement: Outcomes, Indications, Complications, and Innovations. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:81. [DOI: 10.1007/s11936-017-0580-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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43
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He W, Huang RR, Shi QY, Liu XB, Wang JA, Yan M. Bispectral index-guided sedation in transfemoral transcatheter aortic valve implantation: a retrospective control study. J Zhejiang Univ Sci B 2017; 18:353-359. [PMID: 28378573 DOI: 10.1631/jzus.b1600522] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Transcatheter aortic valve implantation (TAVI) is a minimally invasive therapy for elderly patients with severe aortic valve stenosis who were refused surgical aortic valve replacement because of the high perioperative risk. Traditionally, this procedure has been done under general anesthesia, but more recently local anesthesia and sedation have become popular. This research assessed the effectiveness of transfemoral TAVI under bispectral index (BIS)-guided sedation. METHODS In this single-center retrospective control analysis, clinical data, including demographic characteristics, echocardiography, periprocedural data, and main complications, were collected and assessed in 113 patients undergoing TAVI through the femoral artery under general anesthesia (GA group, n=36) and under BIS-guided sedation (SED group, n=77). RESULTS The demographic characteristics and echocardiographic parameters between the two groups were similar (P>0.05). Two (2.6%) of patients were moved from BIS-guided sedation to general anesthesia for surgical reasons. Procedures were significantly shorter in the SED group than in the GA group ((127.10±44.43) min vs. (165.90±71.62) min, P=0.004). Patients in the SED group lost less blood and received significantly fewer red blood cells and catecholamines than those in the GA group (5.19% vs. 22.22%, P=0.017 and 67.53% vs. 97.22%, P<0.001). The length of hospital stay was significantly shorter and there were fewer pulmonary complications in the SED group than in the GA group. Thirty-day mortality was similar between the two groups. CONCLUSIONS BIS-guided sedation is a feasible and safe approach for transfemoral TAVI. The anesthesiologist should choose the best anesthetic method according to the team's experience.
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Affiliation(s)
- Wei He
- Department of Anesthesia, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Rong-Rong Huang
- Department of Anesthesia, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Qing-Yu Shi
- Department of Anesthesia, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Xian-Bao Liu
- Department of Cardiology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Jian-An Wang
- Department of Cardiology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Min Yan
- Department of Anesthesia, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
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Alkhalil A, Lamba H, Deo S, Bezerra HG, Patel SM, Markowitz A, Simon DI, Costa MA, Davis AC, Attizzani GF. Safety of shorter length of hospital stay for patients undergoing minimalist transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2017; 91:345-353. [DOI: 10.1002/ccd.27230] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 07/16/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Ahmad Alkhalil
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center; Cleveland Ohio
| | - Harveen Lamba
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center; Cleveland Ohio
| | - Salil Deo
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center; Cleveland Ohio
| | - Hiram G. Bezerra
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center; Cleveland Ohio
| | - Sandeep M. Patel
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center; Cleveland Ohio
| | - Alan Markowitz
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center; Cleveland Ohio
| | - Daniel I. Simon
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center; Cleveland Ohio
| | - Marco A. Costa
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center; Cleveland Ohio
| | - Angela C. Davis
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center; Cleveland Ohio
| | - Guilherme F. Attizzani
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center; Cleveland Ohio
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Villablanca PA, Mohananey D, Nikolic K, Bangalore S, Slovut DP, Mathew V, Thourani VH, Rode's-Cabau J, Núñez-Gil IJ, Shah T, Gupta T, Briceno DF, Garcia MJ, Gutsche JT, Augoustides JG, Ramakrishna H. Comparison of local versus general anesthesia in patients undergoing transcatheter aortic valve replacement: A meta-analysis. Catheter Cardiovasc Interv 2017; 91:330-342. [DOI: 10.1002/ccd.27207] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 06/15/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Pedro A. Villablanca
- Division of Cardiovascular Diseases; Montefiore Medical Center/Albert Einstein College of Medicine; New York New York
| | | | | | | | - David P. Slovut
- Division of Cardiovascular Diseases; Montefiore Medical Center/Albert Einstein College of Medicine; New York New York
- Department of Cardiothoracic and Vascular Surgery; Montefiore Medical Center/Albert Einstein College of Medicine; New York New York
| | - Verghese Mathew
- Division of Cardiology; Loyola University Stritch School of Medicine; Maywood Illinois
| | - Vinod H. Thourani
- Division of Cardiothoracic Surgery; Emory University School of Medicine; Atlanta Georgia
| | | | | | - Tina Shah
- Department of Internal Medicine; Montefiore Medical Center/Albert Einstein College of Medicine; New York New York
| | - Tanush Gupta
- Division of Cardiovascular Diseases; Montefiore Medical Center/Albert Einstein College of Medicine; New York New York
| | - David F. Briceno
- Division of Cardiovascular Diseases; Montefiore Medical Center/Albert Einstein College of Medicine; New York New York
| | - Mario J. Garcia
- Division of Cardiovascular Diseases; Montefiore Medical Center/Albert Einstein College of Medicine; New York New York
| | - Jacob T. Gutsche
- Department of Anesthesiology and Critical Care; Perelman School of Medicine, University of Pennsylvania; Philadelphia Pennsylvania
| | - John G. Augoustides
- Department of Anesthesiology and Critical Care; Perelman School of Medicine, University of Pennsylvania; Philadelphia Pennsylvania
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Terzian Z, Urena M, Himbert D, Gardy-Verdonk C, Iung B, Bouleti C, Brochet E, Ghodbane W, Depoix JP, Nataf P, Vahanian A. Causes and temporal trends in procedural deaths after transcatheter aortic valve implantation. Arch Cardiovasc Dis 2017; 110:607-615. [PMID: 28411108 DOI: 10.1016/j.acvd.2016.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 09/10/2016] [Accepted: 12/16/2016] [Indexed: 10/19/2022]
Abstract
BACKGROUND The causes of procedural deaths after transcatheter aortic valve implantation (TAVI) have been scarcely detailed. AIMS To assess these causes and their temporal trends since the beginning of the TAVI era. METHODS From October 2006 to April 2014, 601 consecutive high-risk/inoperable patients with severe aortic stenosis underwent TAVI using the Edwards SAPIEN or SAPIEN XT or the Medtronic CoreValve. The transfemoral route was the default approach; the transapical or left subclavian approaches were alternative options. Patients were divided into three tertiles according to the date of the procedure. RESULTS Procedural death occurred in 45 patients (7.5%), with a median±standard deviation age of 83±7 years; 23 were men (51%) and the mean logistic EuroSCORE was 26±16%. The main cause of death was heart failure (n=19, 42%), followed by cardiac rupture (n=12, 27%), intensive care complications (n=9, 20%) and vascular complications (n=5, 11%). The mortality rate was higher after transapical than transfemoral TAVI (17% vs. 5%; P<0.001). The mortality rate decreased over time (11.9% in the first tertile, 6.0% in the second and 4.5% in the third [P=0.007]), driven by a reduction in heart failure-related deaths (6.5% in the first tertile vs. 1.5% in the third; P=0.011). Vascular complication-related deaths disappeared in the third tertile. However, there was no decrease in deaths related to cardiac ruptures and intensive care complications. CONCLUSIONS The procedural mortality rate of TAVI decreased over time, driven by the decrease in heart failure-related deaths. However, efforts should continue to prevent cardiac ruptures and improve the outcomes of patients requiring intensive care after TAVI.
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Affiliation(s)
- Zaven Terzian
- Cardiology Department, DHU FIRE, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Marina Urena
- Cardiology Department, DHU FIRE, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Dominique Himbert
- Cardiology Department, DHU FIRE, Bichat Hospital, AP-HP, 75018 Paris, France.
| | | | - Bernard Iung
- Cardiology Department, DHU FIRE, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Claire Bouleti
- Cardiology Department, DHU FIRE, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Eric Brochet
- Cardiology Department, DHU FIRE, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Walid Ghodbane
- Cardiac Surgery Department, DHU FIRE, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Jean-Pol Depoix
- Anaesthesiology Department, DHU FIRE, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Patrick Nataf
- Cardiac Surgery Department, DHU FIRE, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Alec Vahanian
- Cardiology Department, DHU FIRE, Bichat Hospital, AP-HP, 75018 Paris, France
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Kakefuda Y, Hayashida K, Yamada Y, Yashima F, Inohara T, Yanagisawa R, Tanaka M, Arai T, Kawakami T, Maekawa Y, Tsuruta H, Itabashi Y, Murata M, Sano M, Okamoto K, Yoshitake A, Shimizu H, Jinzaki M, Fukuda K. Impact of Subclinical Vascular Complications Detected by Systematic Postprocedural Multidetector Computed Tomography After Transcatheter Aortic Valve Implantation Using Balloon-Expandable Edwards SAPIEN XT Heart Valve. Am J Cardiol 2017; 119:1100-1105. [PMID: 28162223 DOI: 10.1016/j.amjcard.2016.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 12/15/2016] [Accepted: 12/15/2016] [Indexed: 12/20/2022]
Abstract
Complications after transcatheter aortic valve implantation (TAVI) remain an important issue. This study aimed to evaluate the impact of systematic postprocedural multidetector computed tomography (MDCT) to detect subclinical complications after TAVI. From October 2013 to August 2015, a total of 135 patients who underwent transfemoral TAVI (n = 116) or transapical TAVI (n = 19) with Sapien XT and MDCT preprocedure and postprocedure were enrolled. Postprocedural MDCT findings were compared with the preprocedural MDCT findings. Cardiovascular complications were observed in 25.9% of patients, including 6 cases (4.5%) with major complications. Of those, clinically apparent major complications were reported in 2 cases including rupture of the sinus of Valsalva and iliac rupture. The complications in the remaining 4 cases (3.0%) included aortic dissection, aortic intramural hematoma, and left ventricular apical pseudoaneurysm, which were totally asymptomatic and only detected by MDCT. The apical pseudoaneurysm required surgical repair. Minor complications were observed in 21.5% of patients, 50% of which were subclinical. Only 1 case with femoral pseudoaneurysm required an additional procedure. Noncardiovascular findings were detected in 27.4% of patients; the most frequent were pleural effusions and atelectasis, which were predominantly observed in those treated through a transapical approach. Contrast-induced acute kidney injury after postprocedural MDCT was reported in 1 patient whose clinical course was complicated by sepsis. In conclusion, postprocedural MDCT was useful in detecting important subclinical complications that may affect the clinical course without deterioration of renal function.
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Affiliation(s)
- Yuki Kakefuda
- Department of Cardiology, Keio University School of Medicine, Japan; Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Japan.
| | - Yoshitake Yamada
- Department of Diagnostic Radiology, Keio University School of Medicine, Japan
| | - Fumiaki Yashima
- Department of Cardiology, Keio University School of Medicine, Japan
| | - Taku Inohara
- Department of Cardiology, Keio University School of Medicine, Japan
| | - Ryo Yanagisawa
- Department of Cardiology, Keio University School of Medicine, Japan
| | - Makoto Tanaka
- Department of Cardiology, Keio University School of Medicine, Japan
| | - Takahide Arai
- Department of Cardiology, Keio University School of Medicine, Japan
| | - Takashi Kawakami
- Department of Cardiology, Keio University School of Medicine, Japan
| | - Yuichiro Maekawa
- Department of Cardiology, Keio University School of Medicine, Japan
| | - Hikaru Tsuruta
- Department of Cardiology, Keio University School of Medicine, Japan
| | - Yuji Itabashi
- Department of Cardiology, Keio University School of Medicine, Japan
| | | | - Motoaki Sano
- Department of Cardiology, Keio University School of Medicine, Japan
| | - Kazuma Okamoto
- Department of Cardiovascular Surgery, Keio University School of Medicine, Japan
| | - Akihiro Yoshitake
- Department of Cardiovascular Surgery, Keio University School of Medicine, Japan
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery, Keio University School of Medicine, Japan
| | - Masahiro Jinzaki
- Department of Diagnostic Radiology, Keio University School of Medicine, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Japan
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Konia MR, Helmer G, Raveendran G, Aposolidou I. Anesthetic Implications of Chronic Lung Disease in Patients Undergoing Transcatheter Valve Implantation. J Cardiothorac Vasc Anesth 2017; 31:657-662. [DOI: 10.1053/j.jvca.2016.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Indexed: 11/11/2022]
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Aksoy M, Ilker Ince II, Ahiskalioglu A. Anaesthesia Techniques in Transfemoral Transcatheter Aortic Valve Implantation: A Brief Review. EUROPEAN MEDICAL JOURNAL 2017. [DOI: 10.33590/emj/10312194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is an alternative, less invasive method to use for aortic valve replacement in high-risk patients. This operation allows a faster recovery, reduced tissue damage, less postoperative pain, increased patient satisfaction, reduced intensive care unit (ICU) stay, avoidance of ICU admission, reduced hospital stay, and reduced wound infection rates. A retrograde transfemoral approach is commonly used in TAVI procedures. The role of the anaesthetist is important for a successful outcome. General or local anaesthesia, with or without conscious sedation, may be used according to patient characteristics, the presence of comorbidities, and the preference of the surgical team. There is no general consensus regarding which patients should receive general or local anaesthesia during TAVI operations; therefore, the surgical team’s preference has an important influence on the selection of anaesthetic technique. There are many studies in the literature relating to the anaesthesia technique used in TAVI operations. No matter which technique is used, anaesthetists should provide and maintain optimal haemodynamic stability during the procedure. On the other hand, anaesthetists should be cautious of possible procedural complications, such as hypotension, ventricular fibrillation, permanent pacemaker requirement, and emergency aortic valve replacement requirement.
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Affiliation(s)
- Mehmet Aksoy
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Ilker Ince Ilker Ince
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Ali Ahiskalioglu
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Atatürk University, Erzurum, Turkey
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Currie ME, McLeod AJ, Moore JT, Chu MWA, Patel R, Kiaii B, Peters TM. Augmented Reality System for Ultrasound Guidance of Transcatheter Aortic Valve Implantation. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 11:31-9; discussion 39. [PMID: 26938173 DOI: 10.1097/imi.0000000000000235] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Transcatheter aortic valve implantation (TAVI) relies on fluoroscopy and nephrotoxic contrast medium for valve deployment. We propose an alternative guidance system using augmented reality (AR) and transesophageal echocardiography (TEE) to guide TAVI deployment. The goals of this study were to determine how consistently the aortic valve annulus is defined from TEE using different aortic valve landmarks and to compare AR guidance with fluoroscopic guidance of TAVI deployment in an aortic root model. METHODS Magnetic tracking sensors were integrated into the TAVI catheter and TEE probe, allowing these tools to be displayed in an AR environment. Variability in identifying aortic valve commissures and cuspal nadirs was assessed using TEE aortic root images. To compare AR guidance of TAVI deployment with fluoroscopic guidance, a TAVI stent was deployed 10 times in the aortic root model using each of the two guidance systems. RESULTS Commissures and nadirs were both investigated as features for defining the valve annulus in the AR guidance system. The commissures were identified more consistently than the nadirs, with intraobserver variability of 2.2 and 3.8 mm, respectively, and interobserver variability of 3.3 and 4.7 mm, respectively. The precision of TAVI deployment using fluoroscopic guidance was 3.4 mm, whereas the precision of AR guidance was 2.9 mm, and its overall accuracy was 3.4 mm. This indicates that both have similar performance. CONCLUSIONS Aortic valve commissures can be identified more reliably than cuspal nadirs from TEE. The AR guidance system achieved similar deployment accuracy to that of fluoroscopy while eliminating the use and consequences of nephrotoxic contrast and radiation.
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Affiliation(s)
- Maria E Currie
- From the *Division of Cardiac Surgery, Department of Surgery, London Health Sciences Centre, London, ON, Canada; †Canadian Surgical Technologies & Advanced Robotics, Lawson Health Research Institute, London, ON, Canada; ‡Medical Imaging Laboratory, Robarts Research Institute, Western University, London, ON, Canada; and §Department of Surgery, Schulich School of Medicine & Dentistry, and ∥Electrical and Computer Engineering, Western University, London, ON, Canada
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