Sedation or general anesthesia for patients undergoing transcatheter aortic valve implantation—does it affect outcome? An observational single-center study

Goren, Or; Finkelstein, Ariel; Gluch, Andrei; Sheinberg, Nechama; Dery, Elia; Matot, Idit

doi:10.1016/j.jclinane.2015.03.025

Cited by 41 publications

(49 citation statements)

References 21 publications

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“…This advantage was also found by some other researchers (Goren et al, 2015). Preexisting pulmonary infection, TEE insertion, long procedure time, and the high incidence of blood transfusion may be the main reasons for the high rate of pulmonary complications in our sample.…”

Section: Bis-guided Sedation Vs General Anesthesiasupporting

confidence: 88%

Bispectral index-guided sedation in transfemoral transcatheter aortic valve implantation: a retrospective control study

Huang

Shi

et al. 2017

J. Zhejiang Univ. Sci. B

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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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Section: Bis-guided Sedation Vs General Anesthesiasupporting

confidence: 88%

Bispectral index-guided sedation in transfemoral transcatheter aortic valve implantation: a retrospective control study

Huang

Shi

et al. 2017

J. Zhejiang Univ. Sci. B

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“…Thus, some authors argue that more hemodynamic stability requiring less inotropic support may be provided by sedation in awake patients safely undergoing TAVI (24). This was confirmed by another study as well (18). On the other hand, Dehedin et al found not only significantly less hemodynamic instability and a shorter length of hospital stay in the monitored anesthesia care (MAC) group compared to the GA group, but also a significantly lower requirement for vasoactive or inotropic drug use.…”

Section: Discussionmentioning

confidence: 84%

“…In another study, there was a trend toward more postprocedural pulmonary complications in the GA group (18).…”

Section: Discussionmentioning

confidence: 90%

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Impact of different anesthetic managements in outcomes of transcatheteraortic valve implantation: the first Turkish experience

Kesimci¹,

Erkılıç²,

Gümüş³

et al. 2016

Turk J Med Sci

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We investigated the data of patients retrospectively in regards to anesthetic issues. Between July 2011 and January 2014, 151 TAVI procedures were performed via a transaxillary (n = 3) or transfemoral (n = 148) approach at our institution.Routinely, following the evaluation of the individual patient on the basis of international recommendations by the cardiologist, cardiac surgeon, and anesthesiologist, a decision for not only high risk of conventional surgery but also the suitability of TAVI is made in our clinics (8-12). Preoperatively, in addition to clinical evaluation, all patients are screened by transthoracic echocardiography (TTE), coronary angiography, iliofemoral contrast angiography, and computed tomography. Thus, the anesthesiologist determines the anesthetic management to be offered.For this report, the patients were followed up in the aspect of clinical data, transthoracic echocardiographic results, parameters related to the procedure, and intensive care unit and hospital stay lengths until hospital discharge. Afterwards, information on survival in the following 30 days was obtained by telephoning the patient. We Background/aim: Transcatheter aortic valve implantation (TAVI) has emerged as a new therapy in aortic stenosis patients with high operative risk. Advances in experiences have shifted the choice of anesthesia from general to local anesthesia and sedation for these patients. We compared our anesthetic experiences in our institute in a period of 2.5 years. Materials and methods:A total of 151 (86 females, 65 males, mean age 76 years) symptomatic aortic stenosis patients undergoing transfemoral TAVI under general anesthesia (GA) (n = 79) and local anesthesia and sedation (LAS) (n = 72) were evaluated retrospectively in regards to anesthetic issues. Results:The mean European System for Cardiac Operative Risk Evaluation (EuroSCORE) values of patients in the GA and LAS groups were 17 and 12, respectively. The anesthesia duration was significantly shorter in the LAS group (P < 0.001) and 16.7% of the patients in the LAS group were switched to general anesthesia. Length of stay in the intensive care unit was similar in the two groups.Conclusion: TAVI, applied in high-risk populations, has many challenges for anesthesiologists. With technological advances, it is possible to perform these procedures under sedation with variable advantages. Thus, future studies in regard to anesthesia are required for the success of the procedure and patient safety.

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“…Anesthetic agents, such as fentanyl, propofol, dexmedetomidine, and midazolam, have never been reported to influence blood platelets. Recent data, using propensity score-matching analysis, showed less procedural duration, less fluoroscopic time, and more postprocedural complications in a non-GA cohort [17,18]. Longer X-ray exposure, longer procedural time, and larger contrast amounts have been reported to be associated with TP, which might help to elucidate this correlation between TP and anesthesia techniques [9].…”

Section: Discussionmentioning

confidence: 99%

Predictors of Thrombocytopenia after Self-Expandable Transcatheter Aortic Valve Replacement: A Single-Center Experience from China

Zhu¹,

Liu²,

et al. 2018

Cardiology

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Objectives: The importance of thrombocytopenia (TP) has been discussed previously. However, data are still limited, especially on predictors of TP. We sought to investigate predictors of TP after transcatheter aortic valve replacement (TAVR), in particular, clinically significant TP. Methods: We reviewed a total of 123 consecutive patients undergoing TAVR in our medical center. They were stratified into 3 groups according to the nadir platelet count post-TAVR: no/mild TP, moderate TP, and severe TP. Clinically significant TP, also known as major TP, was defined as moderate-to-severe TP (a nadir platelet count <100 × 10⁹/L and a >50% decrease in platelet count). Results: Baseline platelet, baseline hemoglobin, general anesthesia (GA), valve malpositioning and post-TAVR left ventricular ejection fraction were found to be predictors of post-TAVR nadir platelet count. Major TP was associated with a higher risk of major bleeding (OR 3.524, 95% CI 1.546-8.031) and 1-month mortality (OR 11.226, 95% CI 1.208-104.328). Age (OR 1.110, 95% CI 1.014-1.215) and GA (OR 6.494, 95% CI 2.058-20.408) were predictors of major TP. Conclusion: Post-TAVR nadir platelet count can be predicted based on baseline and procedural data. Old age and GA contribute to clinically significant TP.

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Sedation or general anesthesia for patients undergoing transcatheter aortic valve implantation—does it affect outcome? An observational single-center study

Cited by 41 publications

References 21 publications

Bispectral index-guided sedation in transfemoral transcatheter aortic valve implantation: a retrospective control study

Bispectral index-guided sedation in transfemoral transcatheter aortic valve implantation: a retrospective control study

Impact of different anesthetic managements in outcomes of transcatheteraortic valve implantation: the first Turkish experience

Predictors of Thrombocytopenia after Self-Expandable Transcatheter Aortic Valve Replacement: A Single-Center Experience from China

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