MedStar Authors catalog › Details for: Comparison of clinical outcomes with the utilization of monitored anesthesia care vs. general anesthesia in patients undergoing transcatheter aortic valve replacement.
Normal view MARC view ISBD view

Comparison of clinical outcomes with the utilization of monitored anesthesia care vs. general anesthesia in patients undergoing transcatheter aortic valve replacement.

by Kiramijyan, Starkis; Ben-Dor, Itsik; Koifman, Edward; Didier, Romain; Magalhaes, Marco A; Escarcega, Ricardo O; Negi, Smita I; Baker, Nevin C; Gai, Jiaxiang; Torguson, Rebecca; Okubagzi, Petros; Asch, Federico M; Wang, Zuyue; Gaglia, Michael AJ; Satler, Lowell F; Pichard, Augusto D; Waksman, Ron.
Citation: Cardiovascular Revascularization Medicine. 17(6):384-90, 2016 Sep.Journal: Cardiovascular revascularization medicine : including molecular interventions.Published: 2016ISSN: 1878-0938.Full author list: Kiramijyan S; Ben-Dor I; Koifman E; Didier R; Magalhaes MA; Escarcega RO; Negi SI; Baker NC; Gai J; Torguson R; Okubagzi P; Asch FM; Wang Z; Gaglia MA Jr; Satler LF; Pichard AD; Waksman R.UI/PMID: 27133500.Subject(s): Aged | Aged, 80 and over | Anesthesia/ae [Adverse Effects] | *Anesthesia/mt [Methods] | Anesthesia/mo [Mortality] | Anesthesia, General/ae [Adverse Effects] | Anesthesia, General/mo [Mortality] | *Anesthesia, General | Aortic Valve/dg [Diagnostic Imaging] | Aortic Valve/pp [Physiopathology] | *Aortic Valve | Aortic Valve Stenosis/dg [Diagnostic Imaging] | Aortic Valve Stenosis/mo [Mortality] | Aortic Valve Stenosis/pp [Physiopathology] | *Aortic Valve Stenosis/th [Therapy] | Cardiac Catheterization/ae [Adverse Effects] | Cardiac Catheterization/is [Instrumentation] | Cardiac Catheterization/mo [Mortality] | *Cardiac Catheterization | 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] | *Heart Valve Prosthesis Implantation | Hospital Mortality | Humans | Kaplan-Meier Estimate | Length of Stay | Male | Retrospective Studies | Risk Factors | Severity of Illness Index | Time Factors | Treatment OutcomeInstitution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Comparative Study | Journal Article | Observational StudyDigital Object Identifier: https://dx.doi.org/10.1016/j.carrev.2016.02.003 (Click here) Abbreviated citation: Cardiovasc Revasc Med. 17(6):384-90, 2016 Sep.Local Holdings: Available in print through MWHC library: 2002 - present.Abstract: 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.Abstract: 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.Abstract: 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.Abstract: 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.Abstract: Copyright © 2016. Published by Elsevier Inc.

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