Comparison of anesthesia management in transcatheter aortic valve implantation: a retrospective cohort study

Erkan, Gönül; Özyaprak, Buket; Kaya, Ferdane Aydoğdu; Dursun, İhsan; Korkmaz, Levent

doi:10.1016/j.bjane.2021.06.017

Cited by 4 publications

(3 citation statements)

References 26 publications

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“…Debido a que la estenosis aórtica suele representar un problema de salud importante en personas mayores, debe determinarse con objetividad cuando y como tratarse el reemplazo valvular aórtico puede ser con técnica quirúrgica abierta o con reemplazo valvular transcatéter 14 .…”

Section: Resultados Y Discusiónunclassified

Implantación de Válvula Aórtica Transcáteter (TAVI). Sedación y Anestesia Regional: Reporte de Caso

Núñez Cacho,

Torres Sosa

2024

Ciencia Latina

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Introducción: La estenosis aórtica (EA) por calcificación es la valvulopatía más común en los países desarrollados, teniendo gran relevancia en la población geriátrica. Se caracteriza por la limitación de la eyección del ventrículo izquierdo. La prevalencia reportada a nivel mundial es de 1.3% entre los 65-74 años, 2.8% después de los 75 años y 9.8% entre los 80-89 años. Después de confirmar la estenosis valvular se debe establecer el riesgo quirúrgico del paciente. En pacientes de bajo riesgo se deben considerar la dimension de la estenosis y el tamaño del vaso para elegir el modelo y tamaño de la prótesis basandose en la evaluación ecocardiográfica; así como poder decidir que técnica de reemplazo es más conveniente, ya sea técnica quirúrgica o transcutánea; en pacientes con riesgo intermedio-alto se debe considerar la técnica transcutanea (TAVI) como primer opción debido a que ha demostrado mejores resultados en comparación con la técnica quirúrgica. El manejo anestésico suele ser con el paciente bajo anestesia general o anestesia local y sedación; la elección de la técnica anestésica dependerá de la experiencia del hospital en el procedimiento y preferencia del cirujano. Sin embargo, recientemente hay un incremento en lo reportado en la literatura sobre la seguridad y eficacia de la anestesia local con el paciente bajo sedación consciente. Teniendo ventajas como mayor estabilidad hemodinámica, menor afección en la precarga, disminución en el tiempo quirúrgico, valoración neurológica inmediata, menos días de estancia hospitalaria y disminución en la tasa de mortalidad. Caso clínico: Se presenta un caso clínico de un paciente femenino de 62 años de edad que fue intervenida para implantación de válvula aórtica transcatéter, manejada con sedación endovenosa y bloqueo de nervio femoral. Conclusiones: La técnica anestésica con el paciente bajo sedación ha demostrado ser útil y segura en el manejo de la implantación valvular aórtica transcatéter, teniendo en consideración una adecuada profundidad anestésica para evitar movimientos involuntarios y posibles complicaciones. El bloqueo de nervio femoral tiene utilidad como adyuvante para disminuir las molestias derivadas del abordaje por vía femoral así como brindar analgesia postoperatoria. La terapia antitrombótica es crucial en el seguimiento de los pacientes para prevenir la disfunción valvular.

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Section: Resultados Y Discusiónunclassified

Implantación de Válvula Aórtica Transcáteter (TAVI). Sedación y Anestesia Regional: Reporte de Caso

Núñez Cacho,

Torres Sosa

2024

Ciencia Latina

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“…In our study, MAC was the most commonly used anesthetic technique, and this finding is in accordance with other European and North American centers [ 10 ]. Although studies suggest there are no differences between general anesthesia and MAC in terms of mortality or major complications after TAVR, MAC appears to be associated with shorter procedure duration as well as intensive care and hospital length of stay [ 11 - 12 ]. This choice could be further explained by the fact that patients are usually old with multiple comorbidities.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Corticosteroids and Pacemaker Implantation After Transcatheter Aortic Valve Replacement

Tiago,

Dias Vaz,

Marques

et al. 2024

Cureus

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Background: Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of aortic stenosis. However, conduction disturbances leading to pacemaker implantation remain a common complication, increasing morbidity and mortality in these patients. Hence, measures to lower its incidence should be taken, and corticosteroid therapy could be effective by reducing inflammation caused by direct mechanical trauma to the conduction system. Methods: A retrospective cohort study was conducted at the Centro Hospitalar de Vila Nova de Gaia/Espinho, analyzing the medical records of patients with native severe aortic stenosis who underwent transfemoral TAVR in 2022. The Chi-square test was used to compare the rate of pacemaker implantation in patients who received corticosteroids with patients who didn't. The statistical significance was considered for a p-value <0.05. Results: A total of 341 patients were included in this study. Monitored anesthesia care was the preferred anesthetic technique (99.1%). Sixty-three point three percent (63.3%) of patients received corticosteroids at the beginning of the procedure. Corticosteroid administration did not significantly affect the incidence of permanent pacemaker implantation (p=0.277), vascular complications on the access site (p=0.765), or in-hospital mortality (p=0.909). Male gender, 1st-degree atrioventricular block, and right branch block were the only identified predictors of permanent pacemaker implantation after transfemoral TAVR (p=0.041 <0.001 and <0.001, respectively). Conclusion: Corticosteroid administration at the beginning of TAVR doesn’t seem to influence the incidence of permanent pacemaker implantation, which can suggest that other factors play a more important role in the development of conduction disturbances leading to pacemaker implantation.

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“…Patients undergoing sedation with local anesthesia need a lower amount of inotropic agents and a shorter intensive care unit stay than those under general anesthesia, but both techniques show similar complication rates and mortality. For this reason, the current scientific evidence does not support one technique over another [12], [13].…”

Section: Introductionmentioning

confidence: 88%

Dexmedetomidine for transcatheter aortic valve implantation. Does it protect against acute kidney injury?

Haro¹,

García²,

Alcantara³

et al. 2023

Rev. chil. anest.

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Introduction: Acute kidney injury (AKI) is a frequent complication after transcatheter aortic valve implantation (TAVI), and it presents a higher risk of myocardial infarction, severe bleeding, transfusion, dialysis, and mortality. Dexmedetomidine has a protective effect on AKI after adult cardiac surgery. We want to study the impact of dexmedetomidine on the incidence of AKI in the postoperative period of TAVI procedure in our center. Methods: We performed a retrospective cohort study comparing the administration of dexmedetomidine (DEX group) versus other sedatives (NO-DEX group) during elective TAVI procedure under transfemoral approach. Results: A total of 122 patients were included in the study. Both groups presented a similar incidence of AKI (19,8% DEX group; 19,2% NO-DEX group; p = 0,949). A subgroup analysis with patients presenting chronic kidney disease showed an AKI incidence of 24%, without statistically significant differences between both groups either. Conclusions: We did not find any difference on AKI incidence, length of hospital stay, 30-day mortality or 12-month mortality in patients undergoing TAVI procedure under sedation with dexmedetomidine compared to other sedatives in our center. It would be interesting to study this hypothetical association through studies with larger samples and better designs.

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Comparison of anesthesia management in transcatheter aortic valve implantation: a retrospective cohort study

Cited by 4 publications

References 26 publications

Implantación de Válvula Aórtica Transcáteter (TAVI). Sedación y Anestesia Regional: Reporte de Caso

Implantación de Válvula Aórtica Transcáteter (TAVI). Sedación y Anestesia Regional: Reporte de Caso

Intraoperative Corticosteroids and Pacemaker Implantation After Transcatheter Aortic Valve Replacement

Dexmedetomidine for transcatheter aortic valve implantation. Does it protect against acute kidney injury?

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