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Tomey MI. Intensive Care after Transcatheter Aortic Valve Replacement. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Szerlip M, Tabachnick D, Hamandi M, Caras L, Lanfear AT, Squiers JJ, Harrington K, Potluri SP, DiMaio JM, Wooley J, Pollock B, Schaffer JM, Brinkman WT, Brown DL, Mack MJ. Safe implementation of enhanced recovery after surgery protocol in transfemoral transcatheter aortic valve replacement. Proc (Bayl Univ Med Cent) 2020; 34:5-10. [PMID: 33456136 DOI: 10.1080/08998280.2020.1810198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Enhanced recovery after surgery (ERAS) protocols are gaining wide acceptance. We evaluated ERAS protocol implementation in transfemoral transcatheter aortic valve replacement (TAVR) patients. The ERAS protocol included (1) moderate sedation or general anesthesia with on-table extubation, (2) no pulmonary artery or urinary catheters, (3) arterial line removal within 4 hours, (4) no postoperative narcotics, (5) mobilization at 4 hours and ambulation within 8 hours, and (6) antihypertensive reinstitution without nodal blockers. Patients who received TAVR before and after ERAS implementation were compared (N = 121 and N = 368, respectively). The primary endpoint was total hospital length of stay (LOS). ERAS patients had a lower mean Society of Thoracic Surgeons predicted risk of mortality (6.7% vs 7.5%; P = 0.04). Unadjusted analysis demonstrated that ERAS was associated with significantly decreased mean LOS (2.8 vs 4.0 days, P < 0.001), decreased 30-day mortality (0.8% vs 5.0%; P = 0.003), and increased discharge home (90.2% vs 79.3%, P = 0.002) with no increase in 30-day readmission (11.1% vs 14.0%, P = 0.39). After risk adjustment, ERAS patients had a 1.87-day shorter LOS (P = 0.001) and trended toward increased discharge home (odds ratio 1.76, P = 0.078) without increased readmission (odds ratio 0.74, P = 0.4). An ERAS protocol for TAVR is safe and is associated with shorter LOS without increased readmission.
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Affiliation(s)
- Molly Szerlip
- Cardiovascular Research Department, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - Deborah Tabachnick
- Cardiovascular Research Department, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - Mohanad Hamandi
- Cardiovascular Research Department, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - LuAnn Caras
- Cardiovascular Research Department, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - Allison T Lanfear
- Cardiovascular Research Department, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - John J Squiers
- Cardiovascular Research Department, Baylor Scott and White The Heart Hospital, Plano, Texas.,General Surgery Department, Baylor University Medical Center, Dallas, Texas
| | - Katherine Harrington
- Cardiovascular Research Department, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - Srinivasa P Potluri
- Cardiovascular Research Department, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - J Michael DiMaio
- Cardiovascular Research Department, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - Jordan Wooley
- Cardiovascular Research Department, Baylor Scott and White The Heart Hospital, Plano, Texas
| | | | - Justin M Schaffer
- Cardiovascular Research Department, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - William T Brinkman
- Cardiovascular Research Department, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - David L Brown
- Cardiovascular Research Department, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - Michael J Mack
- Cardiovascular Research Department, Baylor Scott and White The Heart Hospital, Plano, Texas
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Lo J, Hill C. Intensive care unit management of transcatheter aortic valve recipients. Semin Cardiothorac Vasc Anesth 2016; 19:95-105. [PMID: 25975594 DOI: 10.1177/1089253215575183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Severe aortic stenosis is an increasingly prevalent disease that continues to be associated with significant mortality. Transcatheter aortic valve replacements have been used as an alternative to surgical aortic valve replacement in high-risk patients with multiple comorbidities. In this review, we discuss postoperative considerations pertinent to the successful management of these complicated patients in the intensive care unit.
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Affiliation(s)
- Joyce Lo
- Stanford University, Stanford, CA, USA
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Abstract
Aortic stenosis is a common problem that typically results from calcification and degenerative changes of the aortic valve that occur with advancing age. Because medical therapies have no clinically proven role, the management of severe aortic stenosis has primarily been surgical. For patients who are too high-risk for surgical aortic valve repair, transcatheter aortic valve repair (TAVR), approved by the FDA in 2011, may be an option. This article outlines what clinicians need to know about TAVR.
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