Comparison of clinical outcomes with the utilization of monitored anesthesia care vs. general anesthesia in patients undergoing transcatheter aortic valve replacement.
Comparison of clinical outcomes with the utilization of monitored anesthesia care vs. general anesthesia in patients undergoing transcatheter aortic valve replacement.
- 2016
Available in print through MWHC library: 2002 - present
BACKGROUND: There is no clear consensus in regard to the optimal anesthesia utilization during transcatheter aortic valve replacement (TAVR). The aim was to compare outcomes of transfemoral (TF) TAVR under monitored anesthesia care (MAC) vs. general anesthesia (GA) and evaluate the rates and causes of intra-procedural MAC failure. CONCLUSIONS: TF TAVR under MAC is feasible and safe, results in shorter hospital stays, can be performed in the majority of cases, and should be utilized as the default strategy. Trans-esophageal echocardiography utilization during TAVR with MAC is safe and feasible. The most common cause for conversion of MAC to GA is cardiac instability and hypotension. The complete heart team should be available at all times in case the need arises for a rapid conversion to GA. Copyright © 2016. Published by Elsevier Inc. METHODS: All consecutive patients who underwent TF TAVR from April 2007 through March 2015 were retrospectively analyzed and dichotomized into two groups: TAVR under MAC vs. GA. The main endpoints of the study included 30-day and 1-year mortality, the rates and reasons for failure of MAC, in-hospital clinical safety outcomes, and post-procedural hospital and intensive care unit length-of-stays. RESULTS: A total of 533 patients (51% male, mean-age 83years) underwent TF TAVR under MAC (n=467) or GA (n=66). Fifty-six patients (12%) in the MAC group required conversion to GA. The MAC group had significantly shorter post-procedural hospital (6.0 vs. 7.9, p=0.023) and numerically shorter ICU (2.4 vs. 2.8, p=0.355) mean length-of-stays in days. The clinical safety outcomes were similar in both groups. Kaplan-Meier unadjusted cumulative in-hospital and 30-day mortality rates were higher in the GA group but similar in both groups at 1-year.
English
1878-0938
*Anesthesia, General
*Anesthesia/mt [Methods]
*Aortic Valve
*Aortic Valve Stenosis/th [Therapy]
*Cardiac Catheterization
*Heart Valve Prosthesis Implantation
Aged
Aged, 80 and over
Anesthesia, General/ae [Adverse Effects]
Anesthesia, General/mo [Mortality]
Anesthesia/ae [Adverse Effects]
Anesthesia/mo [Mortality]
Aortic Valve Stenosis/dg [Diagnostic Imaging]
Aortic Valve Stenosis/mo [Mortality]
Aortic Valve Stenosis/pp [Physiopathology]
Aortic Valve/dg [Diagnostic Imaging]
Aortic Valve/pp [Physiopathology]
Cardiac Catheterization/ae [Adverse Effects]
Cardiac Catheterization/is [Instrumentation]
Cardiac Catheterization/mo [Mortality]
Catheterization, Peripheral
Echocardiography, Transesophageal
Female
Femoral Artery
Heart Valve Prosthesis Implantation/ae [Adverse Effects]
Heart Valve Prosthesis Implantation/is [Instrumentation]
Heart Valve Prosthesis Implantation/mo [Mortality]
Hospital Mortality
Humans
Kaplan-Meier Estimate
Length of Stay
Male
Retrospective Studies
Risk Factors
Severity of Illness Index
Time Factors
Treatment Outcome
MedStar Heart & Vascular Institute
Comparative Study
Journal Article
Observational Study
Available in print through MWHC library: 2002 - present
BACKGROUND: There is no clear consensus in regard to the optimal anesthesia utilization during transcatheter aortic valve replacement (TAVR). The aim was to compare outcomes of transfemoral (TF) TAVR under monitored anesthesia care (MAC) vs. general anesthesia (GA) and evaluate the rates and causes of intra-procedural MAC failure. CONCLUSIONS: TF TAVR under MAC is feasible and safe, results in shorter hospital stays, can be performed in the majority of cases, and should be utilized as the default strategy. Trans-esophageal echocardiography utilization during TAVR with MAC is safe and feasible. The most common cause for conversion of MAC to GA is cardiac instability and hypotension. The complete heart team should be available at all times in case the need arises for a rapid conversion to GA. Copyright © 2016. Published by Elsevier Inc. METHODS: All consecutive patients who underwent TF TAVR from April 2007 through March 2015 were retrospectively analyzed and dichotomized into two groups: TAVR under MAC vs. GA. The main endpoints of the study included 30-day and 1-year mortality, the rates and reasons for failure of MAC, in-hospital clinical safety outcomes, and post-procedural hospital and intensive care unit length-of-stays. RESULTS: A total of 533 patients (51% male, mean-age 83years) underwent TF TAVR under MAC (n=467) or GA (n=66). Fifty-six patients (12%) in the MAC group required conversion to GA. The MAC group had significantly shorter post-procedural hospital (6.0 vs. 7.9, p=0.023) and numerically shorter ICU (2.4 vs. 2.8, p=0.355) mean length-of-stays in days. The clinical safety outcomes were similar in both groups. Kaplan-Meier unadjusted cumulative in-hospital and 30-day mortality rates were higher in the GA group but similar in both groups at 1-year.
English
1878-0938
*Anesthesia, General
*Anesthesia/mt [Methods]
*Aortic Valve
*Aortic Valve Stenosis/th [Therapy]
*Cardiac Catheterization
*Heart Valve Prosthesis Implantation
Aged
Aged, 80 and over
Anesthesia, General/ae [Adverse Effects]
Anesthesia, General/mo [Mortality]
Anesthesia/ae [Adverse Effects]
Anesthesia/mo [Mortality]
Aortic Valve Stenosis/dg [Diagnostic Imaging]
Aortic Valve Stenosis/mo [Mortality]
Aortic Valve Stenosis/pp [Physiopathology]
Aortic Valve/dg [Diagnostic Imaging]
Aortic Valve/pp [Physiopathology]
Cardiac Catheterization/ae [Adverse Effects]
Cardiac Catheterization/is [Instrumentation]
Cardiac Catheterization/mo [Mortality]
Catheterization, Peripheral
Echocardiography, Transesophageal
Female
Femoral Artery
Heart Valve Prosthesis Implantation/ae [Adverse Effects]
Heart Valve Prosthesis Implantation/is [Instrumentation]
Heart Valve Prosthesis Implantation/mo [Mortality]
Hospital Mortality
Humans
Kaplan-Meier Estimate
Length of Stay
Male
Retrospective Studies
Risk Factors
Severity of Illness Index
Time Factors
Treatment Outcome
MedStar Heart & Vascular Institute
Comparative Study
Journal Article
Observational Study