The effect of anesthesia management on mortality and morbidity in patients who underwent transcatheter aortic valve implantation

Sermin Eminoglu 1 * , Umran Karaca 1, Seyda Efsun Ozgunay 1, Hasan Ari 2, Nermin Kilicarslan 1, Ayse Neslihan Balkaya 1
More Detail
1 Department of Anesthesiology and Reanimation, University of Health Sciences, Bursa Yuksek Ihtisas Research and Education Hospital, Bursa, Turkey
2 Department of Cardiology, University of Health Sciences, Bursa Yuksek Ihtisas Research and Education Hospital, Bursa, Turkey
* Corresponding Author
J CLIN MED KAZ, Volume 19, Issue 3, pp. 40-44. https://doi.org/10.23950/jcmk/12114
OPEN ACCESS 1255 Views 742 Downloads
Download Full Text (PDF)

ABSTRACT

Objectives: We aimed at investigating the effects of two different anesthesia techniques in our patients who underwent transcatheter aortic valve implantation (TAVI).
Material and methods: The effects of two different anesthetic methods were retrospectively evaluated in 100 patients who underwent TAVI between January 2010 and October 2020. Patients were divided into a general anesthesia (GA) group and a sedation-local anesthesia (S-LA) group according to the anesthetic methods used.
Results: Of 100 patients who underwent transcatheter aortic valve implantation, 20 (20%) received GA, and 80 (80%) received S-LA. The mean ages of the patient groups undergoing GA and S-LA were 76.20±7.22 and 75±8.44 years, respectively. The duration of the procedure and anesthesia was significantly longer in the GA patient group than in the S-LA patient group. With the exception of the logistic European Society of Cardiac Operative Risk Assessment, the demographic and preoperative data of the two groups were similar. The most common comorbidity in both groups was hypertension. When comparing complications between groups, the incidence of intraoperative hemodynamic instability, ephedrine use, inotropic drug use, intra-aortic balloon pump placement, postoperative infection and cardiac tamponade was significantly higher in the GA group. The length of intensive care and hospital stay was similar between the groups, but the 30-day and 3-month mortality rates were significantly higher in the GA group than in the S-LA group.
Conclusion: S-LA provided more stable hemodynamics, shorter operative and anesthetic times, fewer intraoperative and postoperative complications, and reduced mortality. S-LA application during the TAVI procedure is a more reliable alternative to GA.
Keywords: general anesthesia, sedation, aortic valve stenosis, transcatheter aortic valve implantation

CITATION

Eminoglu S, Karaca U, Ozgunay SE, Ari H, Kilicarslan N, Balkaya AN. The effect of anesthesia management on mortality and morbidity in patients who underwent transcatheter aortic valve implantation. J CLIN MED KAZ. 2022;19(3):40-4. https://doi.org/10.23950/jcmk/12114

REFERENCES

  • Eveborn GW, Schirmer H, Heggelund G, Lunde P, Rasmussen K. The evolving epidemiology of valvular aortic stenosis. the Tromsøstudy. Heart. 2013;99(6):396-400. https://doi.org/10.1136/heartjnl-2012-302265
  • Sever K, Konukoglu O, Yildirim O, Kilercik H, Mansuroglu D. Sutureless Aortic Valve Replacement. J Coll Physicians Surg Pak. 2021;31(08):891-96 https://doi.org/10.29271/jcpsp.2021.08.891
  • Otto CM, Prendergast B. Aortic-valve stenosis-from patients at risk to severe valve obstruction. N Engl J Med. 2014;371(8):744-56. https://doi.org/10.1056/NEJMra1313875
  • Dichtl W, Alber HF, Feuchtner GM, Hintringer F, Reinthaler M, Bartel T. et al. Prognosis and risk factors in patients with asymptomatic aortic stenosis andtheir modulation by atorvastatin (20mg). Am J Cardiol. 2008;102(6):743-48. https://doi.org/10.1016/j.amjcard.2008.04.060
  • Bach DS, Siao D, Girard SE, Duvernoy C, McCallister Jr BD, Gualano SK. Evaluation of patientswith severe symptomatic aortic stenosis who do not undergoaortic valve replacement: the potential role of subjectively over estimated operative risk. Circ Cardiovasc Qual Outcomes. 2009;2(6):533-39. https://doi.org/10.1161/CIRCOUTCOMES.109.848259
  • Cribier A, Eltchaninoff H, Bash A, Borenstein N, Tron C, Bauer F. et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation. 2002;106(24):3006-8. https://doi.org/10.1161/01.cir.0000047200.36165.b8
  • Klein AA, Skubas NJ, Ender J. Controversies and complications in the perioperative management of transcatheter aortic valve replacement. Anesth Analg. 2014;119(4):784-98. https://doi.org/10.1213/ANE.0000000000000400
  • Yamamoto M, Meguro K, Mouillet G, Bergoend E, Monin JL, Lim P. et al. Effect of local anesthetic management with conscious sedation in patientsundergoing transcatheter aortic valve implantation. Am J Cardiol. 2013;111(1):94-99. https://doi.org/10.1016/j.amjcard.2012.08.053
  • Çiftci A, Kesimci E, Gümüs T, Erkılıc E, Kurtulgu N, Özcan, Kanbak O. Our anesthesia experiences in transcatheter aortic valve surgery patients performed under local anesthesia and sedation. GKDA Derg. 2014;20(4):202-8. https://doi.org/10.5222/GKDAD.2014.202
  • Adams DH, Popma JJ, Reardon MJ, Yakubov SJ, Coselli JS, Deeb GM.et al. Transcatheter aortic-valve replacement with a self-expanding prosthesis. N Engl J Med. 2014;370(19):1790-98. https://doi.org/10.1056/NEJMoa1400590
  • Lindman BR, Pibarot P, Arnold SV, Suri RM, McAndrew TC, Maniar HS. et al. Transcatheter versussurgical aortic valve replacement in patients with diabetes andsevere aortic stenosis at high risk for surgery: an analysis of the PARTNER 13 Trial (Placement of Aortic Transcatheter Valve). JAm Coll Cardiol. 2014;63(11):1090-9. https://doi.org/10.1016/j.jacc.2013.10.057
  • Fassl J. Transcatheter aortic valve implantation should be performed with general anesthesia. J Cardiothorac Vasc Anesth. 2012;26(4):733-5. https://doi.org/10.1053/j.jvca.2012.02.010
  • Brecker SJ, Bleiziffer S, Bosmans J, Gerckens U, Tamburino C, Wenaweser P. et al. Impact of Anesthesia Type on Outcomes of Transcatheter Aortic Valve Implantation (from the Multicenter ADVANCE Study). Am J Cardiol. 2016;117(8):1332-8. https://doi.org/10.1016/j.amjcard.2016.01.027
  • Büyükçoban S, Karaoğlan Lİ. Evaluation of the Factors Affecting the Length of Stay in Hospital of Transcatheter Aortic Valve Implantation (TAVI) Cases. J Basic Clin Health. 2021;5(1): 22-9. https://doi.org/10.30621/jbachs.857712
  • Çakıer RD, Özcan GF, Demirgan S, Okuyan E, Selcan A. Our Anesthetic Managements in Patients Undergoing Transcatheter Aortic Valve Implantation (TAVI): A Retrospective Study. SCTAIC. 2020;26(3):139-46. https://doi.org/10.5222/GKDAD.2020.93824
  • Dall’Ara G, Eltchaninoff H, Moat N, Laroche C, Goicolea J, Ussia GP, et al. Local and general anaesthesia do not influence outcome of transfemoral aortic valve implantation. Int J Cardiol. 2014; 177(2): 448-54. https://doi.org/10.1016/j.ijcard.2014.09.025
  • Lange R, Bleiziffer S, Piazza N, Mazzitelli D, Hutter A, Tassani-Prell P, et al. Incidence and treatment of procedural cardiovascular complications associated with trans-arterial and trans-apical interventional aortic valve implantation in 412 consecutive patients. Eur J Cardiothorac Surg. 2011;40(5):1105-13. https://doi.org/10.1016/j.ejcts.2011.03.022
  • Azizoglu M, Özdemir L, Özkan B, Doruk N. Transkateter Aortik Valv Implantasyonu İşleminde Anestezi Deneyimlerimiz. JARSS. 2018;26(3):164-8. https://doi.org/10.5222/GKDAD.2014.202
  • Guinot PG, Depoix JP, Etchegoyen L, Benbara A, Provenchère S, Dilly MP, et al. Anesthesia and perioperative management of patients undergoing transcatheter aortic valve implantation: analysis of 90 consecutive patients with focus on perioperative complications. J Cardiothorac Vasc Anesth. 2010; 24(5):752-61. https://doi.org/10.1053/j.jvca.2009.12.019
  • Guarracino F, Landoni G. Con: Transcatheter aortic valve implantation should not be performed under general anesthesia. J Cardiothorac Vasc Anesth. 2012;26(6):736-9. https://doi.org/10.1053/j.jvca.2012.01.052
  • Villablanca PA, Mohananey D, Nikolic K, Bangalore S, Slovut DP, Mathewet V, et al. Comparison of local versus general anesthesia in patients undergoing transcatheter aortic valve replacement: A metaanalysis. Catheter Cardiovasc Interv. 2018;91(2):330-42. https://doi.org/10.1002/ccd.27207
  • Hyman MC, Vemulapalli S, Szeto WY, Stebbins A, Patel PA, Matsouaka RA, et al. Conscious sedation versus general anesthesia for transcatheter aortic valve replacement: insights from the National cardiovascular data registry Society of thoracic Surgeons/American College of cardiology transcatheter valve therapy registry. Circulation. 2017;136(22):2132-40. https://doi.org/10.1161/CIRCULATIONAHA.116.026656
  • Butala NM, Chung M, Secemsky EA, Manandhar P, Marquis-Gravel G, Kosinski AS, et al. Conscious sedation versus general anesthesia for transcatheter aortic valve replacement: variation in practice and outcomes. JACC Cardiovascular Interv. 2020;13(11):1277-87. https://doi.org/10.1016/j.jcin.2020.03.008
  • Ehret C, Rossaint R, Foldenauer AC, Stoppe C, Stevanovic A, Dohms K, et al. 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(9):e016321 https://doi.org/10.1136/bmjopen-2017-016321
  • Mosleh W, Mather JF, Amer MR, Hiendlmayr B, Kiernan FJ, McKay RG. Propensity matched analysis comparing conscious sedation versus general anesthesia in transcatheter aortic valve implantation. Am J Cardiol. 2019;124(1):70-7. https://doi.org/10.1016/j.amjcard.2019.03.042