1
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Miyoshi H, Kamiya S, Ikeda T, Narasaki S, Kondo T, Syourin D, Sumii A, Kido K, Otsuki S, Kato T, Nakamura R, Tsutsumi YM. Impact of proficiency in the transcatheter aortic valve implantation procedure on clinical outcomes: a single center retrospective study. BMC Anesthesiol 2024; 24:209. [PMID: 38907200 PMCID: PMC11191309 DOI: 10.1186/s12871-024-02594-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 06/10/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND We used transcatheter aortic valve implantation (TAVI) procedure time to investigate the association between surgical team maturity and outcome. METHODS Among patients who underwent TAVI between October 2015 and November 2019, those who had Sapien™ implanted with the transfemoral artery approach were included in the analysis. We used TAVI procedure time and surgery number to draw a learning curve. Then, we divided the patients into two groups before and after the number of cases where the sigmoid curve reaches a plateau. We compared the two groups regarding the surveyed factors and investigated the correlation between the TAVI procedure time and survey factors. RESULTS Ninety-nine of 149 patients were analysed. The sigmoid curve had an inflection point in 23.2 cases and reached a plateau in 43.0 cases. Patients in the Late group had a shorter operating time, less contrast media, less radiation exposure, and less myocardial escape enzymes than the Early group. Surgical procedure time showed the strongest correlation with the surgical case number. CONCLUSION The number of cases required for surgeon proficiency for isolated Sapien™ valve implantation was 43. This number may serve as a guideline for switching the anesthesia management of TAVI from general to local anesthesia.
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Affiliation(s)
- Hirotsugu Miyoshi
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.
| | - Satoshi Kamiya
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Tsuyoshi Ikeda
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Soshi Narasaki
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Takashi Kondo
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Daiki Syourin
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Ayako Sumii
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Kenshiro Kido
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Sachiko Otsuki
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Takahiro Kato
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Ryuji Nakamura
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Yasuo M Tsutsumi
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
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2
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Jaffar-Karballai M, Al-Tawil M, Roy S, Kayali F, Vankad M, Shazly A, Zeinah M, Harky A. Local versus General Anaesthesia for Transcatheter Aortic Valve Implantation (TAVI): A Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomised and Propensity-Score Matched Studies. Curr Probl Cardiol 2024; 49:102360. [PMID: 38128636 DOI: 10.1016/j.cpcardiol.2023.102360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 12/18/2023] [Indexed: 12/23/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) is a common practice for severe aortic stenosis, but the choice between general (GA) and local anesthesia (LA) remains uncertain. We conducted a comprehensive literature review until April 2023, comparing the safety and efficacy of LA versus GA in TAVI procedures. Our findings indicate significant advantages of LA, including lower 30-day mortality rates (RR: 0.69; 95% CI [0.58, 0.82]; p < 0.001), shorter in-hospital stays (mean difference: -0.91 days; 95% CI [-1.63, -0.20]; p = 0.01), reduced bleeding/transfusion incidents (RR: 0.64; 95% CI [0.48, 0.85]; p < 0.01), and fewer respiratory complications (RR: 0.56; 95% CI [0.42, 0.76], p<0.01). Other operative outcomes were comparable. Our findings reinforce prior evidence, presenting a compelling case for LA's safety and efficacy. While patient preferences and clinical nuances must be considered, our study propels the discourse towards a more informed anaesthesia approach for TAVI procedures.
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Affiliation(s)
| | | | - Sakshi Roy
- School of Medicine, Queen's University Belfast, Northern Ireland, UK
| | | | | | - Ahmed Shazly
- Essex Cardiothoracic Centre, Basildon University Hospital, Basildon, UK
| | - Mohamed Zeinah
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK; Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK; Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK.
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3
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Srinivasan A, Wong F, Wang B. Transcatheter aortic valve replacement: Past, present, and future. Clin Cardiol 2024; 47:e24209. [PMID: 38269636 PMCID: PMC10788655 DOI: 10.1002/clc.24209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 01/26/2024] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has emerged as a ground-breaking, minimally invasive alternative to traditional open-heart surgery, primarily designed for elderly patients initially considered unsuitable for surgical intervention due to severe aortic stenosis. As a result of successful large-scale trials, TAVR is now being routinely applied to a broader spectrum of patients. In deciding between TAVR and surgical aortic valve replacement, clinicians evaluate various factors, including patient suitability and anatomy through preprocedural imaging, which guides prosthetic valve sizing and access site selection. Patient surgical risk is a pivotal consideration, with a multidisciplinary team making the ultimate decision in the patient's best interest. Periprocedural imaging aids real-time visualization but is influenced by anaesthesia choices. A comprehensive postprocedural assessment is critical due to potential TAVR-related complications. Numerous trials have demonstrated that TAVR matches or surpasses surgery for patients with diverse surgical risk profiles, ranging from extreme to low risk. However, long-term follow-up data, particularly in low-risk cases, remains limited, and the applicability of published results to younger patients is uncertain. This review delves into key TAVR studies, pinpointing areas for potential improvement while delving into the future of this innovative procedure. Furthermore, it explores the expanding role of TAVR technology in addressing other heart valve replacement procedures.
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Affiliation(s)
- Akash Srinivasan
- Division of Medical Sciences, Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
| | - Felyx Wong
- Guy's and St Thomas’ NHS Foundation TrustLondonUK
| | - Brian Wang
- Department of Metabolism, Digestion and Reproduction, Faculty of MedicineImperial College LondonLondonUK
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4
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Kitaura A, Tsukimoto S, Sakamoto H, Hamasaki S, Nakao S, Nakajima Y. A retrospective comparative study of anesthesia with remimazolam and remifentanil versus dexmedetomidine and remifentanil for transcatheter aortic valve replacement. Sci Rep 2023; 13:17074. [PMID: 37816802 PMCID: PMC10564871 DOI: 10.1038/s41598-023-43895-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/29/2023] [Indexed: 10/12/2023] Open
Abstract
Remimazolam, an ultrashort-acting benzodiazepine, allows for rapid and reliable arousal. Rapid awakening using remimazolam may be beneficial in transcatheter aortic valve replacement (TAVR), as it allows rapid detection of neurologic deficits. The purpose of this study was to compare arousal time and outcomes between monitored anesthesia care (MAC) with remimazolam and remifentanil and conventional MAC with dexmedetomidine, propofol, and remifentanil. This study was a single center retrospective study. All TAVR cases performed under MAC (MAC-TAVR) at our institution between 2019 and 2021 were included. Patients were classified by anesthesia method into remimazolam and dexmedetomidine groups. Among 258 MAC-TAVR patients, 253 were enrolled. After propensity score matching, 76 patients were assigned to each group. The time from end of drug-administration to arousal [20.0 (16.0, 24.0) min vs. 38.5 (30.0, 56.3) min, p < 0.0001] and the time from attempted-arousal to arousal [1.0 (1.0, 1.0) min vs. 12.5 (3.0, 26.8) min, p < 0.0001] were significantly shorter in the remimazolam group. There was no significant difference in the length of ICU stay [2.0 (2.0, 2.0) days vs. 2.0 (2.0, 2.0) days, p = 0.157] and postoperative hospital stay [6.0 (4.0, 9.0) days vs. 5.0 (4.0, 8.0) days, p = 0.262].Trial registration: Clinical trial number: R03-123, Registry URL: https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000051635 Registration number: UMIN000045195, Principal investigator's name: Atsuhiro Kitaura, Date of registration: 20 August 2021.
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Affiliation(s)
- Atsuhiro Kitaura
- Department of Anesthesiology, Kindai University Faculty of Medicine, 377-2 Ono-Higashi, Osakasayama, Osaka, Japan.
| | - Shota Tsukimoto
- Department of Anesthesiology, Kindai University Faculty of Medicine, 377-2 Ono-Higashi, Osakasayama, Osaka, Japan
| | - Hiroatsu Sakamoto
- Department of Anesthesiology, Kindai University Faculty of Medicine, 377-2 Ono-Higashi, Osakasayama, Osaka, Japan
| | - Shinichi Hamasaki
- Department of Anesthesiology, Kindai University Faculty of Medicine, 377-2 Ono-Higashi, Osakasayama, Osaka, Japan
| | - Shinichi Nakao
- Department of Anesthesiology, Kindai University Faculty of Medicine, 377-2 Ono-Higashi, Osakasayama, Osaka, Japan
| | - Yasufumi Nakajima
- Department of Anesthesiology, Kindai University Faculty of Medicine, 377-2 Ono-Higashi, Osakasayama, Osaka, Japan
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5
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Hung KC, Chen JY, Hsing CH, Chu CC, Lin YT, Pang YL, Teng IC, Chen IW, Sun CK. Conscious sedation/monitored anesthesia care versus general anesthesia in patients undergoing transcatheter aortic valve replacement: A meta-analysis. Front Cardiovasc Med 2023; 9:1099959. [PMID: 36704470 PMCID: PMC9872395 DOI: 10.3389/fcvm.2022.1099959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 12/26/2022] [Indexed: 01/11/2023] Open
Abstract
Background To compare the merits and safety between conscious sedation/monitored anesthesia (CS/MAC) and general anesthesia (GA) for patients receiving transcatheter aortic valve replacement (TAVR). Measurements Databases including EMBASE, MEDLINE, and the Cochrane Library databases were searched from inception to October 2022 to identify studies investigating the impact of CS/MAC on peri-procedural and prognostic outcomes compared to those with GA. The primary outcome was the association of CS/MAC with the risk of 30-day mortality, while secondary outcomes included the risks of adverse peri-procedural (e.g., vasopressor/inotropic support) and post-procedural (e.g., stroke) outcomes. Subgroup analysis was performed based on study design [i.e., cohort vs. matched cohort/randomized controlled trials (RCTs)]. Main results Twenty-four studies (observational studies, n = 22; RCTs, n = 2) involving 141,965 patients were analyzed. Pooled results revealed lower risks of 30-day mortality [odd ratios (OR) = 0.66, p < 0.00001, 139,731 patients, certainty of evidence (COE): low], one-year mortality (OR = 0.72, p = 0.001, 4,827 patients, COE: very low), major bleeding (OR = 0.61, p = 0.01, 6,888 patients, COE: very low), acute kidney injury (OR = 0.71, p = 0.01, 7,155 patients, COE: very low), vasopressor/inotropic support (OR = 0.25, p < 0.00001, 133,438 patients, COE: very low), shorter procedure time (MD = -12.27 minutes, p = 0.0006, 17,694 patients, COE: very low), intensive care unit stay (mean difference(MD) = -7.53 h p = 0.04, 7,589 patients, COE: very low), and hospital stay [MD = -0.84 days, p < 0.00001, 19,019 patients, COE: very low) in patients receiving CS/MAC compared to those undergoing GA without significant differences in procedure success rate, risks of cardiac-vascular complications (e.g., myocardial infarction) and stroke. The pooled conversion rate was 3.1%. Results from matched cohort/RCTs suggested an association of CS/MAC use with a shorter procedural time and hospital stay, and a lower risk of vasopressor/inotropic support. Conclusion Compared with GA, our results demonstrated that the use of CS/MAC may be feasible and safe in patients receiving TAVR. However, more evidence is needed to support our findings because of our inclusion of mostly retrospective studies. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42022367417.
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Affiliation(s)
- Kuo-Chuan Hung
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung City, Taiwan,Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Jen-Yin Chen
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Chung-Hsi Hsing
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan,Department of Medical Research, Chi Mei Medical Center, Tainan City, Taiwan
| | - Chin-Chen Chu
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Yao-Tsung Lin
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Yu-Li Pang
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - I-Chia Teng
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - I-Wen Chen
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan City, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, Kaohsiung City, Taiwan,College of Medicine, I-Shou University, Kaohsiung City, Taiwan,*Correspondence: Cheuk-Kwan Sun,
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6
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Erkan G, Ozyaprak B, Kaya FA, Dursun İ, Korkmaz L. Comparison of anesthesia management in transcatheter aortic valve implantation: a retrospective cohort study. Braz J Anesthesiol 2021; 72:629-636. [PMID: 34252453 PMCID: PMC9515671 DOI: 10.1016/j.bjane.2021.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 06/02/2021] [Accepted: 06/20/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We aimed to investigate the effects of two different anesthetic techniques in our patients who underwent transcatheter aortic valve implantation (TAVI). METHODS In this study, 303 patients who underwent TAVI procedure with a diagnosis of severe aortic stenosis between January 1, 2012 and December 31, 2018 were retrospectively evaluated. The patients were divided according to the type of anesthesia given during each procedure as; general anesthesia (GA), local anesthesia (LA). RESULTS LA was preferred in 245 (80.8%) of 303 patients who underwent TAVI, while GA was preferred in 58 patients (19.1%). Median ages of our patients who received LA and GA were 83 and 84, respectively. The procedure and anesthesia durations of the patients in the GA group were longer than the LA group (p< 0.00001, p < 0.00001, respectively). Demographic and pre-operative clinical data were similar in comparison between two groups (p > 0.05) except for peripheral artery disease. Hypertension was the most common comorbidity in both groups. While the number of inotrope use was significantly higher in patients who received GA (p < 0.00001), no significant differences were found between LA and GA patients in terms of major complications and mortality (p > 0.05). Intensive care and hospital stays were significantly shorter in the LA group (p = 0.001, p = 0.023, respectively). CONCLUSION The anesthetic technique of TAVI procedure did not have a significant effect on outcomes including; complications, mortality and success of the procedure. LA provides shorter duration of procedure and hospital stay.
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Affiliation(s)
- Gönül Erkan
- Health Sciences University, Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Anesthesiology and Reanimation, Trabzon, Turkey
| | - Buket Ozyaprak
- Health Sciences University, Bursa Yüksek Ihtisas Training and Research Hospital, Department of Anesthesiology and Reanimation, Bursa, Turkey
| | - Ferdane Aydoğdu Kaya
- Health Sciences University, Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Anesthesiology and Reanimation, Trabzon, Turkey
| | - İhsan Dursun
- Health Sciences University, Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Trabzon, Turkey.
| | - Levent Korkmaz
- Health Sciences University, Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Trabzon, Turkey
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7
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Piayda K, Hellhammer K, Nielsen-Kudsk JE, Schmidt B, Mazzone P, Berti S, Fischer S, Lund J, Montorfano M, Della Bella P, Gage R, Zeus T. Clinical outcomes of patients undergoing percutaneous left atrial appendage occlusion in general anaesthesia or conscious sedation: data from the prospective global Amplatzer Amulet Occluder Observational Study. BMJ Open 2021; 11:e040455. [PMID: 33762228 PMCID: PMC7993182 DOI: 10.1136/bmjopen-2020-040455] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate the safety and efficacy of percutaneous left atrial appendage occlusion (LAAO) using conscious sedation (CS). BACKGROUND Several percutaneous structural heart disease interventions are safely and efficiently performed using CS instead of general anaesthesia (GA). This concept has not been evaluated in a large multicenter cohort of patients undergoing LAAO. METHODS Patients from the prospective, global Amplatzer Amulet Occluder Observational Study were divided into two groups (GA vs CS). Baseline information, periprocedural and postprocedural efficacy and complications, as well as outcomes through 7 days post implant were compared. RESULTS Patients undergoing transesophageal-guided implants were categorised by GA (n=607, 64%) or CS (n=342, 36%) usage. Mean age was 75 years in both groups. LAAO technical success was achieved in 99% of both groups. The procedure duration (GA: 35±22 min vs CS: 27±19 min, p<0.001), total amount of contrast medium (GA: 105±81 mL vs CS: 86±66 mL, p<0.001) and fluoroscopic time (GA: 13±9 min vs CS: 12±13 min, p<0.001) were less in CS cases. Procedure-related or device-related serious adverse events during the first 7 days were numerically higher in the CS group (GA: 4.9% vs CS: 7.6%, p=0.114). Peridevice residual flow was absent or ≤5 mm 1-3 months after the procedure in 99.7% of the GA and in 100% of the CS group (p=1.000). CONCLUSIONS In a large global study, LAAO with the Amplatzer Amulet occluder is safe and feasible using CS. Procedure duration and total amount of contrast were less with CS than GA cases. TRIAL REGISTRATION NUMBER NCT02447081; Results.
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Affiliation(s)
- Kerstin Piayda
- Department of Cardiology, Pneumology and Vascular Medicine, Heinrich Heine University Düsseldorf, Duesseldorf, Nordrhein-Westfalen, Germany
| | - Katharina Hellhammer
- Department of Cardiology, Pneumology and Vascular Medicine, Heinrich Heine University Düsseldorf, Duesseldorf, Nordrhein-Westfalen, Germany
| | | | - Boris Schmidt
- Department of Cardiology, Bethanien-Krankenhaus, Frankfurt am Main, Hessen, Germany
| | | | - Sergio Berti
- Department of Cardiology, Fondazione Toscana Gabriele Monasterio per la Ricerca Medica e di Sanita Pubblica, Pisa, Toscana, Italy
| | - Sven Fischer
- Department of Cardiology, Harzklinikum Dorothea Christiane Erxleben GmbH, Quedlinburg, Sachsen-Anhalt, Germany
| | - Juha Lund
- Department of Cardiology, Turku University Hospital, Turku, Finland
| | - Matteo Montorfano
- Department of Interventional Cardiology, Istituto Scientifico Universitario San Raffaele, Milano, Lombardia, Italy
| | - Paolo Della Bella
- Department of Arrhythmology, San Raffaele Hospital, Milano, Lombardia, Italy
| | - Ryan Gage
- Structural Heart, Abbott Cardiovascular-St Paul, Saint Paul, Minnesota, USA
| | - Tobias Zeus
- Department of Cardiology, Pneumology and Vascular Medicine, Heinrich Heine University Düsseldorf, Duesseldorf, Nordrhein-Westfalen, Germany
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8
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Sammour Y, Kerrigan J, Banerjee K, Gajulapalli RD, Lak H, Chawla S, Andress K, Gupta N, Unai S, Svensson LG, Yun J, Reed GW, Alfirevic A, Sale S, Mehta A, Krishnaswamy A, Skubas N, Kapadia S. Comparing outcomes of general anesthesia and monitored anesthesia care during
transcatheter
aortic valve replacement: The Cleveland Clinic Foundation experience. Catheter Cardiovasc Interv 2021; 98:E436-E443. [DOI: 10.1002/ccd.29496] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 01/13/2021] [Indexed: 12/24/2022]
Affiliation(s)
- Yasser Sammour
- Heart and Vascular Institute Cleveland Clinic Foundation Cleveland Ohio USA
| | - Jimmy Kerrigan
- Heart and Vascular Institute Cleveland Clinic Foundation Cleveland Ohio USA
| | - Kinjal Banerjee
- Heart and Vascular Institute Cleveland Clinic Foundation Cleveland Ohio USA
| | | | - Hassan Lak
- Heart and Vascular Institute Cleveland Clinic Foundation Cleveland Ohio USA
| | - Sanchit Chawla
- Heart and Vascular Institute Cleveland Clinic Foundation Cleveland Ohio USA
| | - Krystof Andress
- Heart and Vascular Institute Cleveland Clinic Foundation Cleveland Ohio USA
| | - Neha Gupta
- Heart and Vascular Institute Cleveland Clinic Foundation Cleveland Ohio USA
| | - Shinya Unai
- Heart and Vascular Institute Cleveland Clinic Foundation Cleveland Ohio USA
| | - Lars G. Svensson
- Heart and Vascular Institute Cleveland Clinic Foundation Cleveland Ohio USA
| | - James Yun
- Heart and Vascular Institute Cleveland Clinic Foundation Cleveland Ohio USA
| | - Grant W Reed
- Heart and Vascular Institute Cleveland Clinic Foundation Cleveland Ohio USA
| | - Andrej Alfirevic
- Heart and Vascular Institute Cleveland Clinic Foundation Cleveland Ohio USA
| | - Shiva Sale
- Heart and Vascular Institute Cleveland Clinic Foundation Cleveland Ohio USA
| | - Anand Mehta
- Heart and Vascular Institute Cleveland Clinic Foundation Cleveland Ohio USA
| | - Amar Krishnaswamy
- Heart and Vascular Institute Cleveland Clinic Foundation Cleveland Ohio USA
| | - Nikolaos Skubas
- Heart and Vascular Institute Cleveland Clinic Foundation Cleveland Ohio USA
| | - Samir Kapadia
- Heart and Vascular Institute Cleveland Clinic Foundation Cleveland Ohio USA
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9
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Thiele H, Kurz T, Feistritzer HJ, Stachel G, Hartung P, Lurz P, Eitel I, Marquetand C, Nef H, Doerr O, Vigelius-Rauch U, Lauten A, Landmesser U, Treskatsch S, Abdel-Wahab M, Sandri M, Holzhey D, Borger M, Ender J, Ince H, Öner A, Meyer-Saraei R, Hambrecht R, Fach A, Augenstein T, Frey N, König IR, Vonthein R, Rückert Y, Funkat AK, Desch S, Berggreen AE, Heringlake M, de Waha-Thiele S. General Versus Local Anesthesia With Conscious Sedation in Transcatheter Aortic Valve Implantation. Circulation 2020; 142:1437-1447. [DOI: 10.1161/circulationaha.120.046451] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background:
In clinical practice, local anesthesia with conscious sedation (CS) is performed in roughly 50% of patients undergoing transcatheter aortic valve replacement. However, no randomized data assessing the safety and efficacy of CS versus general anesthesia (GA) are available.
Methods:
The SOLVE-TAVI (Comparison of Second-Generation Self-Expandable Versus Balloon-Expandable Valves and General Versus Local Anesthesia in Transcatheter Aortic Valve Implantation) trial is a multicenter, open-label, 2×2 factorial, randomized trial of 447 patients with aortic stenosis undergoing transfemoral transcatheter aortic valve replacement comparing CS versus GA. The primary efficacy end point was powered for equivalence (equivalence margin 10% with significance level 0.05) and consisted of the composite of all-cause mortality, stroke, myocardial infarction, infection requiring antibiotic treatment, and acute kidney injury at 30 days.
Results:
The primary composite end point occurred in 27.2% of CS and 26.4% of GA patients (rate difference, 0.8 [90% CI, −6.2 to 7.8];
P
equivalence
=0.015). Event rates for the individual components were as follows: all-cause mortality, 3.2% versus 2.3% (rate difference, 1.0 [90% CI, −2.9 to 4.8];
P
equivalence
<0.001); stroke, 2.4% versus 2.8% (rate difference, −0.4 [90% CI, −3.8 to 3.8];
P
equivalence
<0.001); myocardial infarction, 0.5% versus 0.0% (rate difference, 0.5 [90% CI, −3.0 to 3.9];
P
equivalence
<0.001), infection requiring antibiotics 21.1% versus 22.0% (rate difference, −0.9 [90% CI, −7.5 to 5.7];
P
equivalence
=0.011); acute kidney injury, 9.0% versus 9.2% (rate difference, −0.2 [90% CI, −5.2 to 4.8];
P
equivalence
=0.0005). There was a lower need for inotropes or vasopressors with CS (62.8%) versus GA (97.3%; rate difference, −34.4 [90% CI, −41.0 to −27.8]).
Conclusions:
Among patients with aortic stenosis undergoing transfemoral transcatheter aortic valve replacement, use of CS compared with GA resulted in similar outcomes for the primary efficacy end point. These findings suggest that CS can be safely applied for transcatheter aortic valve replacement.
Registration:
URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT02737150.
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Affiliation(s)
- Holger Thiele
- Heart Center Leipzig at University of Leipzig, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., S.D.)
- Leipzig Heart Institute, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., Y.R., A.-K.F., S.D.)
| | - Thomas Kurz
- University Clinic Schleswig-Holstein and University Heart Center Lübeck, Germany (T.K., I.E., C.M., R.M.-S., A.E.B., M.H., S.d.W.-T.)
- German Center for Cardiovascular Research (DZHK), Germany (T.K., I.E., C.M., A.L., U.L., R.M.-S., N.F., I.R.K., S.D., S.d.W.-T.)
| | - Hans-Josef Feistritzer
- Heart Center Leipzig at University of Leipzig, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., S.D.)
- Leipzig Heart Institute, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., Y.R., A.-K.F., S.D.)
| | - Georg Stachel
- Heart Center Leipzig at University of Leipzig, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., S.D.)
- Leipzig Heart Institute, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., Y.R., A.-K.F., S.D.)
| | - Philipp Hartung
- Heart Center Leipzig at University of Leipzig, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., S.D.)
- Leipzig Heart Institute, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., Y.R., A.-K.F., S.D.)
| | - Philipp Lurz
- Heart Center Leipzig at University of Leipzig, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., S.D.)
- Leipzig Heart Institute, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., Y.R., A.-K.F., S.D.)
| | - Ingo Eitel
- University Clinic Schleswig-Holstein and University Heart Center Lübeck, Germany (T.K., I.E., C.M., R.M.-S., A.E.B., M.H., S.d.W.-T.)
- German Center for Cardiovascular Research (DZHK), Germany (T.K., I.E., C.M., A.L., U.L., R.M.-S., N.F., I.R.K., S.D., S.d.W.-T.)
| | - Christoph Marquetand
- University Clinic Schleswig-Holstein and University Heart Center Lübeck, Germany (T.K., I.E., C.M., R.M.-S., A.E.B., M.H., S.d.W.-T.)
- German Center for Cardiovascular Research (DZHK), Germany (T.K., I.E., C.M., A.L., U.L., R.M.-S., N.F., I.R.K., S.D., S.d.W.-T.)
| | - Holger Nef
- Universitätsklinikum Marburg/Gießen, Gießen, Germany (H.N., O.D., U.V.-R.)
| | - Oliver Doerr
- Universitätsklinikum Marburg/Gießen, Gießen, Germany (H.N., O.D., U.V.-R.)
| | | | - Alexander Lauten
- German Center for Cardiovascular Research (DZHK), Germany (T.K., I.E., C.M., A.L., U.L., R.M.-S., N.F., I.R.K., S.D., S.d.W.-T.)
- Universitätsklinikum Charité, Campus Benjamin Franklin, Berlin, Germany (A.L., U.L., S.T.)
| | - Ulf Landmesser
- German Center for Cardiovascular Research (DZHK), Germany (T.K., I.E., C.M., A.L., U.L., R.M.-S., N.F., I.R.K., S.D., S.d.W.-T.)
- Universitätsklinikum Charité, Campus Benjamin Franklin, Berlin, Germany (A.L., U.L., S.T.)
| | - Sascha Treskatsch
- Universitätsklinikum Charité, Campus Benjamin Franklin, Berlin, Germany (A.L., U.L., S.T.)
| | - Mohamed Abdel-Wahab
- Heart Center Leipzig at University of Leipzig, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., S.D.)
- Leipzig Heart Institute, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., Y.R., A.-K.F., S.D.)
| | - Marcus Sandri
- Heart Center Leipzig at University of Leipzig, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., S.D.)
| | - David Holzhey
- Heart Center Leipzig at University of Leipzig, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., S.D.)
- Leipzig Heart Institute, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., Y.R., A.-K.F., S.D.)
| | - Michael Borger
- Heart Center Leipzig at University of Leipzig, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., S.D.)
- Leipzig Heart Institute, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., Y.R., A.-K.F., S.D.)
| | - Jörg Ender
- Heart Center Leipzig at University of Leipzig, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., S.D.)
- Leipzig Heart Institute, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., Y.R., A.-K.F., S.D.)
| | - Hüseyin Ince
- Universitätsklinikum Rostock, Germany (H.I., A.Ö.)
| | - Alper Öner
- Universitätsklinikum Rostock, Germany (H.I., A.Ö.)
| | - Roza Meyer-Saraei
- University Clinic Schleswig-Holstein and University Heart Center Lübeck, Germany (T.K., I.E., C.M., R.M.-S., A.E.B., M.H., S.d.W.-T.)
- German Center for Cardiovascular Research (DZHK), Germany (T.K., I.E., C.M., A.L., U.L., R.M.-S., N.F., I.R.K., S.D., S.d.W.-T.)
| | | | - Andreas Fach
- Klinikum Links der Weser, Bremen, Germany (R.H., A.F., T.A.)
| | | | - Norbert Frey
- German Center for Cardiovascular Research (DZHK), Germany (T.K., I.E., C.M., A.L., U.L., R.M.-S., N.F., I.R.K., S.D., S.d.W.-T.)
- University Clinic Schleswig-Holstein, Kiel, Germany (N.F.)
| | - Inke R. König
- German Center for Cardiovascular Research (DZHK), Germany (T.K., I.E., C.M., A.L., U.L., R.M.-S., N.F., I.R.K., S.D., S.d.W.-T.)
- Institut für Medizinische Biometrie und Statistik, University of Lübeck, Germany (I.R.K., R.V.)
| | - Reinhard Vonthein
- Institut für Medizinische Biometrie und Statistik, University of Lübeck, Germany (I.R.K., R.V.)
| | - Yvonne Rückert
- Leipzig Heart Institute, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., Y.R., A.-K.F., S.D.)
| | - Anne-Kathrin Funkat
- Leipzig Heart Institute, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., Y.R., A.-K.F., S.D.)
| | - Steffen Desch
- Heart Center Leipzig at University of Leipzig, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., S.D.)
- Leipzig Heart Institute, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., Y.R., A.-K.F., S.D.)
- German Center for Cardiovascular Research (DZHK), Germany (T.K., I.E., C.M., A.L., U.L., R.M.-S., N.F., I.R.K., S.D., S.d.W.-T.)
| | - Astrid E. Berggreen
- University Clinic Schleswig-Holstein and University Heart Center Lübeck, Germany (T.K., I.E., C.M., R.M.-S., A.E.B., M.H., S.d.W.-T.)
| | - Matthias Heringlake
- University Clinic Schleswig-Holstein and University Heart Center Lübeck, Germany (T.K., I.E., C.M., R.M.-S., A.E.B., M.H., S.d.W.-T.)
| | - Suzanne de Waha-Thiele
- University Clinic Schleswig-Holstein and University Heart Center Lübeck, Germany (T.K., I.E., C.M., R.M.-S., A.E.B., M.H., S.d.W.-T.)
- German Center for Cardiovascular Research (DZHK), Germany (T.K., I.E., C.M., A.L., U.L., R.M.-S., N.F., I.R.K., S.D., S.d.W.-T.)
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10
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Cubero-Gallego H, Dam C, Meca J, Avanzas P. Transcatheter aortic valve replacement (TAVR): expanding indications to low-risk patients. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:960. [PMID: 32953760 PMCID: PMC7475389 DOI: 10.21037/atm.2020.03.155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Aortic stenosis (AS) is the most common cardiac valve disease in developed countries. Transcatheter aortic valve replacement (TAVR) for the treatment of severe symptomatic AS is an accepted therapy option for elderly patients with symptomatic severe AS. Nowadays, TAVR has revolutionized the treatment of AS with an exponential growth worldwide. Both the development of new generation valves and the experience of the operating teams have contributed significantly to decrease the complications rate after TAVR. Several randomized trials have reported similar short- and mid-term results, and even better than surgical aortic valve replacement (SAVR) in patients with high- or intermediate-risk. In addition, two comparison trials in low-risk patients have reported promising results. Therefore, in the future TAVR indications will expand, treating younger and younger patients, with less comorbidities and lower risk. However, the long-term durability of percutaneous prostheses is a matter of debate. The aim of this manuscript is to review available data that support to treat AS in low-risk patients and provide our perspective on the topic.
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Affiliation(s)
- Hector Cubero-Gallego
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Christian Dam
- Department of Cardiac Surgery, Hospital Mexico, San Jose, La Uruca, Costa Rica
| | - Juan Meca
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Pablo Avanzas
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.,Universidad de Oviedo, Oviedo, Spain
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11
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Mayr NP, Pellegrini C, Rheude T, Trenkwalder T, Alvarez-Covarrubias HA, Xhepa E, van der Starre P, Wiesner G, Schunkert H, Tassani-Prell P, Joner M. Early Outcome in Patients Requiring Conversion to General Anesthesia During Transfemoral Transcatheter Aortic Valve Implantation. Am J Cardiol 2020; 127:99-104. [PMID: 32386815 DOI: 10.1016/j.amjcard.2020.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 01/22/2023]
Abstract
Transfemoral Transcatheter Aortic Valve Implantation (tf-TAVI) has become an established therapy-option for patients with symptomatic severe aortic stenosis. Conscious sedation (CS) has proven to be an alternative to general anesthesia . So far, the outcome of patients undergoing unplanned periprocedural conversion from CS to general anesthesia has not been investigated. All patients undergoing transfemoral transcatheter aortic valve implantation in CS between 2014 and 2019 were included. The primary end point was early safety at 30 days according to Valve Academic Research Consortium-2 criteria. The reasons for conversion and length of ICU-/ hospital stay were further analyzed. Of 1,058 included patients 35 (3.3%) required a conversion. The end point was documented in 13 (37%) of the converted and 110 (11%) of nonconverted patients (p < 0.001). The causes were: unrest in 11/35 patients, procedural complications in 10/35 patients, respiratory distress in 8/35, and cardiovascular decompensation in 6 patients (17.1%). Compared with the group without conversion (Median (interquartile range ), 4 [4-5] days), length of hospital stay was longest in the group with procedural complications (6 [1-11] days) followed by cardiovascular decompensation (5 [4-7] days). In conclusion, the conversion rate to general anesthesia was low in a large cohort of unselected transcatheter aortic valve implantation patients. Additionally, hospital stay was longer dependent on the reason for conversion.
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Affiliation(s)
- N Patrick Mayr
- Institut für Anästhesiologie, Deutsches Herzzentrum München, Technische Universität München, Germany.
| | - Costanza Pellegrini
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Germany
| | - Tobias Rheude
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Germany
| | - Teresa Trenkwalder
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Germany
| | - Hector A Alvarez-Covarrubias
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Germany
| | - Erion Xhepa
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Germany
| | - Pieter van der Starre
- Department of Anesthesiology and Perioperative Medicine, Stanford University School of Medicine, Stanford, California
| | - Gunther Wiesner
- Institut für Anästhesiologie, Deutsches Herzzentrum München, Technische Universität München, Germany
| | - Heribert Schunkert
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) e.V., (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Germany
| | - Peter Tassani-Prell
- Institut für Anästhesiologie, Deutsches Herzzentrum München, Technische Universität München, Germany
| | - Michael Joner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) e.V., (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Germany
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12
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Abstract
The UK Transcatheter Aortic Valve Implantation (TAVI) registry has collected data about every TAVI procedure performed in the UK. The latest data are from 2016 when 3250 procedures (49.5 pmp) were performed. There has been no change in the mean age of patients but there has been a shift to lower risk with fall in mean Logistic Euroscore since 2012. The switch from general anaesthetic to conscious sedation has been rapid, and propensity-adjusted analysis has not shown a difference in outcomes. In-hospital mortality has fallen to 1.8% in 2016, and relative survival analysis has shown outcome the same as the matched general population to 3 years. The UK TAVI registry has provided valuable benchmarks, and a risk adjustment model that includes frailty measures has been successfully developed and is available online.
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Affiliation(s)
- Peter F Ludman
- Cardiology Department, Queen Elizabeth Hospital, Birmingham B15 2TH, UK
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13
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Mayr NP. Transfemoral Transcatheter Aortic Valve Replacement: Conscious Sedation for Everyone? JACC Cardiovasc Interv 2020; 13:1288-1290. [PMID: 32499019 DOI: 10.1016/j.jcin.2020.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 10/24/2022]
Affiliation(s)
- N Patrick Mayr
- Deutsches Herzzentrum München, Technische Universität München, Institut für Anästhesiologie, Munich, Germany.
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14
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Analysis of length of stay after transfemoral transcatheter aortic valve replacement: results from the FRANCE TAVI registry. Clin Res Cardiol 2020; 110:40-49. [PMID: 32335689 DOI: 10.1007/s00392-020-01647-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/07/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Currently, there are no recommendations regarding the minimum duration of in-hospital monitoring after transfemoral (TF) transcatheter aortic valve replacement (TAVR) and practices are extremely heterogeneous. We, therefore, aimed to evaluate length of stay (LOS) and predictive factors for late discharge after TF TAVR using data from the FRANCE TAVI registry. METHODS TAVR was performed in 12,804 patients in 48 French centers between 2013 and 2015. LOS was evaluated in 5857 TF patients discharged home. LOS was calculated from TAVR procedure (day 0) to discharge. The study population was divided into three groups based on LOS values. Patients discharged within 3 days constituted the "very early" discharge group, patients with a LOS between 3 and 6 days constituted the "early" discharge group, and patients with a length of stay > 6 days constituted the "late" discharge group. RESULTS The median LOS was 7 (5-9) days and was extremely variable among centers. The proportion of patients discharged very early, early, and late was 4.4% (n = 256), 33.7% (n = 1997), and 61.9% (n = 3624) respectively. Variables associated with late discharge were female sex, co-morbidities, major complications, self-expandable valve, general anesthesia, and a significant center effect. In contrast, history of previous pacemaker was a protective factor. The composite of death and re-admission in the very early and early versus late discharge groups was similar at 30 days (3.3% vs. 3.5%, p = 0.66). CONCLUSIONS LOS is extremely variable after TF TAVR in France. Co-morbidities and complications were predictive factors of late discharge after TAVI. Interestingly, the use of self-expandable prosthesis and general anesthesia may also contribute to late discharge. Our results confirm that early discharge is safe.
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Kalogeras K, Ruparelia N, Kabir T, Jabbour R, Naganuma T, Vavuranakis M, Nakamura S, Wang B, Sen S, Hadjiloizou N, Malik IS, Mikhail G, Dalby M, Panoulas V. Comparison of the self-expanding Evolut-PRO transcatheter aortic valve to its predecessor Evolut-R in the real world multicenter ATLAS registry. Int J Cardiol 2020; 310:120-125. [PMID: 32139239 DOI: 10.1016/j.ijcard.2020.02.070] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 02/16/2020] [Accepted: 02/26/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Evolut PRO self-expanding transcatheter aortic valve has been designed to feature an outer pericardial wrap that aims to reduce paravalvular regurgitation (PVR) rates. Medium-term clinical outcomes, compared to its predecessor Evolut R, in a real-world setting, have not been investigated. The aim of the present study was to compare the two valves with regards to peri-procedural complications, early outcomes and mid-term survival. METHODS Consecutive patients, undergoing TAVI with either the Evolut PRO or Evolut R device, from the multicenter ATLAS registry were retrospectively studied. Outcomes studied included periprocedural complications, PVR at discharge, need for new pacemaker implantation and Kaplan-Meier estimated 1-year all-cause mortality. RESULTS Analysis included 673 patients (498 treated with Evolut R and 175 treated with Evolut PRO). At least moderate PVR was numerically lower amongst patients treated with Evolut PRO (7.4% vs 3.8% for Evolut R and Evolut PRO respectively, p = .108). Rates of new permanent pacemaker (PPM) implantation (21.1% vs. 11.9%, p = .023), and bail-out valve-in-valve (2.4% vs. 0%, p = .049) were significantly lower amongst the Evolut PRO group. No differences were demonstrated regarding bleeding, stroke or acute kidney injury. One-year Kaplan-Meier estimated survival was similar between groups (93% for Evolut R vs. 91.2% for Evolut PRO, plog-rank = 0.806). CONCLUSIONS The Evolut PRO self-expanding valve demonstrates similar mid-term survival rates and numerically, yet not significant, lower incidence of PVR compared to its predecessor. Interestingly this new generation valve is associated with a significantly reduced rate for new PPM implantation. Future studies are required to confirm this finding.
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Affiliation(s)
- Konstantinos Kalogeras
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield Foundation Trust, London, UK; 1st Department of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Greece
| | - Neil Ruparelia
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK; Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust
| | - Tito Kabir
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield Foundation Trust, London, UK
| | - Richard Jabbour
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK; Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Manolis Vavuranakis
- 1st Department of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Greece; 3(rd) Department of Cardiology, Sotiria Hospital, National & Kapodistrian University of Athens, Greece
| | - Sunao Nakamura
- Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Brian Wang
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK; Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust
| | - Sayan Sen
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK; Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust
| | - Nearchos Hadjiloizou
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK
| | - Iqbal S Malik
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK; Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust
| | - Ghada Mikhail
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK; Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust
| | - Miles Dalby
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield Foundation Trust, London, UK; Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK
| | - Vasileios Panoulas
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield Foundation Trust, London, UK; Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK
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17
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Renner J, Tesdorpf A, Freitag‐Wolf S, Francksen H, Petzina R, Lutter G, Frey N, Frank D. A retrospective study of conscious sedation versus general anaesthesia in patients scheduled for transfemoral aortic valve implantation: A single center experience. Health Sci Rep 2019; 2:e95. [PMID: 30697594 PMCID: PMC6346987 DOI: 10.1002/hsr2.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 09/04/2018] [Accepted: 09/17/2018] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES The current 2017 ESC/EACTS guidelines recommend transcatheter aortic valve implantations (TAVIs) as the therapy of choice for inoperable patients with severe symptomatic aortic stenosis. Most of the TAVIs worldwide are performed under general anaesthesia (GA). Although conscious sedation (CS) concepts are increasingly applied in Europe, it is still a matter of debate which concept is associated with highest amount of safety for this high-risk patient population. The aim of this single center, before-and-after study was to investigate feasibility and safety of CS compared with GA with respect to peri-procedural complications and 30-day mortality in patients scheduled for transfemoral TAVI (TF-TAVI). METHODS From March 2012 until September 2014, patients scheduled for the TF-TAVI procedure were included in a prospective, observational manner. From the 200 patients finally included, 107 procedures were performed under GA, using either an endotracheal tube or a laryngeal mask, and balanced anaesthesia. CS was performed in 93 patients using low-dose propofol and remifentanil. RESULTS Conversion to GA was needed 4 times due to procedural-related complications (4.3%), in one patient due to ongoing agitation (1.1%). The CS-group showed significantly shorter key time courses: anaesthesia time (105 [95-120] minutes vs 115 [105-140] minutes, P-value = 0.009, Mann-Whitney-U-test) and length of stay in the intensive care unit (1.6 [1.0-1.5] d vs 2.1 [1.0-2.0] d, P-value = 0.002, Mann-Whitney-U-test). The lowest mean arterial pressure was significantly higher in the CS-group compared with the GA-group (74.3 mmHg vs 55.2 mmHg, P-value <0.0001, t-test). CS was associated with less requirements of norepinephrine (0.1 μg/kg vs 2.3 μg/kg, P-value <0.0001, Mann-Whitney-U-test). CONCLUSIONS Our single-center data demonstrate that CS is a feasible and safe alternative, especially with respect to a higher degree of intra-procedural haemodynamic stability, and a reduced length of stay in the intensive care unit.
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Affiliation(s)
- Jochen Renner
- Department of Anaesthesiology and Intensive Care MedicineUniversity Hospital Schleswig‐HolsteinGermany
| | - Anna Tesdorpf
- Department of Trauma SurgeryUniversity Hospital Schleswig‐HolsteinGermany
| | | | - Helga Francksen
- Department of Anaesthesiology and Intensive Care MedicineUniversity Hospital Schleswig‐HolsteinGermany
| | - Rainer Petzina
- Department for Cardiovascular SurgeryUniversity Hospital Schleswig‐HolsteinGermany
| | - Georg Lutter
- Department for Cardiovascular SurgeryUniversity Hospital Schleswig‐HolsteinGermany
| | - Norbert Frey
- Department of Cardiology and AngiologyUniversity Hospital Schleswig‐HolsteinGermany
| | - Derk Frank
- Department of Cardiology and AngiologyUniversity Hospital Schleswig‐HolsteinGermany
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Kanda H, Toyama Y, Oshiro A, Onodera Y, Kanao-Kanda M, Kamiya H, Kunisawa T. Iatrogenic Gastric Tear Caused by Transesophageal Echocardiography After Transcatheter Aortic Valve Implantation and Treatment with Endoscopic Clipping. J Cardiothorac Vasc Anesth 2018; 33:257-259. [PMID: 30391099 DOI: 10.1053/j.jvca.2018.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Hirotsugu Kanda
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Yuki Toyama
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Akane Oshiro
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Yoshiko Onodera
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Megumi Kanao-Kanda
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Hiroyuki Kamiya
- Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Takayuki Kunisawa
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
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19
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Otto CM. Heartbeat: improving outcomes after myocardial infarction. Heart 2018; 104:1553-1554. [PMID: 30213881 DOI: 10.1136/heartjnl-2018-314028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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