Conscious sedation for transcatheter implantation of atrial septal occluders with two- and three-dimensional transoesophageal echocardiography guidance — a feasibility and safety study

Abstract

A b s t r a c tBackground: General anaesthesia may have negative impact on patient mortality and morbidity, as well as overall procedure costs, in atrial septal occluder (ASO) implantation. Aim:We sought to evaluate the safety, efficacy, and feasibility of conscious sedation for transcatheter implantation of ASOs. Methods:A total of 122 patients referred for transcatheter implantation of ASO were included. Mean patient age was 51 ± 15 years, and 43 (35%) patients were male. The initial dose of midazolam was 2 mg and fentanyl dose was 25 µg. Additional doses of midazolam and fentanyl were administered, if necessary. Patient responsiveness was assessed every 10 min, and the sedatives doses were titrated in order not to exceed grade 3 sedation in the Ramsey scale.Results: Atrial septal occluders were successfully implanted in the majority of patients (98.4%). In two (1.6%) cases the procedure failed because of too small patent foramen ovale (PFO) diameter (n = 1, 0.8%) or device instability (n = 1, 0.8%). The mean duration of procedure was 47.6 ± 28.4 min and was similar for ASD and PFO closure (p = 0.522). The overall mean dose of midazolam was 4.7 ± 2.2 mg (63.9 ± 32.5 µg/kg) and fentanyl was 30.0 ± 11.9 µg (0.43 ± 0.17 µg/kg). Median entrance dose of radiation at the patient plane was 25 (interquartile range: 16-57) mGy, and did not differ between ASD and PFO procedures (p = 0.614). The majority of patients were free of complications (91.0%). The following early complications were observed: transient ischaemic attack (n = 2, 1.6%), supraventricular arrhythmias (n = 4, 3.3%), left atrial thrombus formation (n = 1, 0.8%), symptomatic bradycardia (n = 1, 0.8%), and femoral venous bleeding (n = 5, 4.1%). After mean follow-up of 386 days residual shunt was observed in eight (6.6%) patients. Conclusions:Conscious sedation for transcatheter implantation of ASO is a feasible, safe, and efficient technique, allowing successful PFO and ASD closure in the majority of patients.

Comparison of the efficacy and safety of sedation protocols with the use of dexmedetomidine–remifentanil and propofol–remifentanil during percutaneous closure of atrial septal defects: a randomized clinical trial

“…In this study, there was a longer induction time to achieve targeted levels of sedation with dexmedetomidine than with propofol, which was also similar to the results of previous research above the patients without intracardiac shunts [ 12 ]. However, there is no clinical study involving adequate number of patients has been done to explore the magnitude of difference in the induction time of anesthesia in patients with or without intracardiac shunt [ 27 , 28 ]. Simple dosage regimens based only on patient weight may not result in stable effect-site concentrations because of the complex pharmacokinetics and pharmacodynamics of each drug.…”

Transcatheter closure of atrial septal defect with Chinese and Thai nitinol wire mesh occluders in adult patients

“…Introduction Transcatheter closure of atri al septal defect (ASD) type II can be safely per formed in children and adults. 1,2 Since the im plementation of the Amplatzer septal occluder (ASO) in 1997, many similar nitinol wire mesh Amplatzer like occluders have been developed. Nitinol is an alloy of nickel and titanium.…”