<b>Risk-Adapted Outcome After Endovascular Aortic Aneurysm Repair:</b>Analysis of Anesthesia Types Based on EUROSTAR Data

Ruppert, Volker; Leurs, Lina J.; Rieger, Johannes; Steckmeier, B.; Buth, Jacob; Umscheid, Thomas

doi:10.1583/06-1957.1

Cited by 60 publications

(53 citation statements)

References 19 publications

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“…Although GA appears technically feasible and safe in the majority of patients undergoing TAVI, this observation may challenge the universal use of GA in very high-risk patients and appears to be in line with data from the EUROSTAR registry, where patients treated by endovascular aortic repair for abdominal aortic aneurysms benefited from loco-regional anaesthesia rather than GA with a reduction in both cardiac and pulmonary complications. In the high-risk group, patients treated with LA had lower mortality [29]. It is not appropriate to suggest that our findings coming from an observational study should alter current practice in the management of high-risk TAVI patients.…”

Section: Discussionmentioning

confidence: 84%

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

Dall’Ara¹,

Eltchaninoff²,

Moat³

et al. 2014

International Journal of Cardiology

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Section: Discussionmentioning

confidence: 84%

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

Dall’Ara¹,

Eltchaninoff²,

Moat³

et al. 2014

International Journal of Cardiology

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“…10 In that stratified analysis, the most significant benefits from local and regional anesthesia were seen in patients designated as high risk. Decreased ICU utilization was observed with local anesthesia and decreased early mortality was observed with regional anesthesia in high-risk patients.…”

Section: Discussionmentioning

confidence: 99%

Results of endovascular aortic aneurysm repair with general, regional, and local/monitored anesthesia care in the American College of Surgeons National Surgical Quality Improvement Program database

Edwards

Andrews

Edwards

et al. 2011

Journal of Vascular Surgery

125

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Background This study examined outcomes of endovascular repair of infrarenal abdominal aortic aneurysms (EVAR) using general, spinal, epidural, and local/monitored anesthesia care (MAC) in a multicenter North American hospital database reflecting contemporary anesthesia and surgical practices. Methods Elective EVAR cases performed between 2005 and 2008 were identified from the American College of Surgeons National Surgical Quality Improvement Program database using Current Procedural Terminology codes. Excluded were emergency cases and patients with concomitant procedures requiring general anesthesia. Patient-level comorbidities, characteristics, and intraoperative and postoperative details were examined. Complications were analyzed individually and in aggregate categories, including wound, pulmonary, renal, venous thromboembolic, cardiovascular, operative, and septic. Length of stay (LOS) and 30-day mortality were examined. Characteristics and outcomes were described using mean ± standard deviation or count (%), and comparisons were evaluated for statistical significance using χ2, Fisher exact test, and univariate linear regression. LOS was analyzed with linear regression techniques using a log transformation. Associations between anesthesia type and outcomes were examined using univariable and multivariable regression techniques. Results We identified 6009 elective EVAR procedures for analysis. General anesthesia was used in 4868 cases, spinal anesthesia in 419, epidural anesthesia in 331, and local/MAC in 391. Defined morbidity occurred in 11% of patients. Median LOS was 2 (interquartile range, 1–3) days, and mean LOS was 2.8 ± 4.3 days. The 30-day mortality rate was 1.1%. Significant multivariate associations were observed between anesthesia type, pulmonary morbidity, and log-LOS. General anesthesia was associated with an increase in pulmonary morbidity vs spinal (odds ratio [OR], 4.0; 95% confidence interval [CI], 1.3–12.5; P = .020) and local/MAC anesthesia (OR, 2.6; 95% CI, 1.0–6.4; P = .041). Use of general anesthesia was associated with a 10% increase in LOS for general vs spinal anesthesia (95% CI, 4.8%–15.5%; P = .001) and a 20% increase for general vs local/MAC anesthesia (95% CI, 14.1%–26.2%; P < .001). Trends toward increased pulmonary morbidity and LOS were not observed for general vs epidural anesthesia. No significant association between anesthesia type and mortality was observed. Conclusions In contemporary North American anesthetic and surgical practice, general anesthesia for EVAR was associated with increased postoperative LOS and pulmonary morbidity compared with spinal and local/MAC anesthesia. These data suggest that increasing the use of less-invasive anesthetic techniques may limit postoperative complications and decrease the overall costs of EVAR.

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“…MAC was defined as cardiovascular and respiratory monitoring of the patient by a qualified anesthesiologist who may or may not be administering concomitant sedation. For endovascular aortic aneurysm repair, MAC has proven to be beneficial in a large population of high risk patients [8]. Therefore, the impact of MAC versus GA on outcomes for other interventional endovascular procedures, such as TAVR, which are currently performed predominantly under GA, should also be assessed.…”

Section: Introductionmentioning

confidence: 99%

Local versus general anesthesia for transcatheter aortic valve implantation (TAVR) – systematic review and meta-analysis

Fröhlich

Lansky

Webb

et al. 2014

BMC Med

153

101

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BackgroundThe hypothesis of this study was that local anesthesia with monitored anesthesia care (MAC) is not harmful in comparison to general anesthesia (GA) for patients undergoing Transcatheter Aortic Valve Implantation (TAVR).TAVR is a rapidly spreading treatment option for severe aortic valve stenosis. Traditionally, in most centers, this procedure is done under GA, but more recently procedures with MAC have been reported.MethodsThis is a systematic review and meta-analysis comparing MAC versus GA in patients undergoing transfemoral TAVR. Trials were identified through a literature search covering publications from 1 January 2005 through 31 January 2013. The main outcomes of interest of this literature meta-analysis were 30-day overall mortality, cardiac-/procedure-related mortality, stroke, myocardial infarction, sepsis, acute kidney injury, procedure time and duration of hospital stay. A random effects model was used to calculate the pooled relative risks (RR) with 95% confidence intervals.ResultsSeven observational studies and a total of 1,542 patients were included in this analysis. None of the studies were randomized. Compared to GA, MAC was associated with a shorter hospital stay (-3.0 days (-5.0 to -1.0); P = 0.004) and a shorter procedure time (MD -36.3 minutes (-58.0 to -15.0 minutes); P <0.001). Overall 30-day mortality was not significantly different between MAC and GA (RR 0.77 (0.38 to 1.56); P = 0.460), also cardiac- and procedure-related mortality was similar between both groups (RR 0.90 (0.34 to 2.39); P = 0.830).ConclusionThese data did not show a significant difference in short-term outcomes for MAC or GA in TAVR. MAC may be associated with reduced procedural time and shorter hospital stay. Now randomized trials are needed for further evaluation of MAC in the setting of TAVR.

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Risk-Adapted Outcome After Endovascular Aortic Aneurysm Repair:Analysis of Anesthesia Types Based on EUROSTAR Data

Cited by 60 publications

References 19 publications

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

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

Results of endovascular aortic aneurysm repair with general, regional, and local/monitored anesthesia care in the American College of Surgeons National Surgical Quality Improvement Program database

Local versus general anesthesia for transcatheter aortic valve implantation (TAVR) – systematic review and meta-analysis

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