Anesthesia and Perioperative Management of Patients Who Undergo Transfemoral Transcatheter Aortic Valve Implantation: An Observational Study of General Versus Local/Regional Anesthesia in 125 Consecutive Patients

Dehedin, Benedicte; Guinot, Pierre-Grégoire; Ibrahim, Hassan; Allou, Nicolas; Provenchère, Sophie; Dilly, Marie-Pierre; Vahanian, Alec; Himbert, Dominique; Brochet, Éric; Radu, Costin; Nataf, Patrick; Montravers, Philippe; Longrois, Dan; Depoix, Jean‐Pol

doi:10.1053/j.jvca.2011.05.008

Cited by 115 publications

(85 citation statements)

References 26 publications

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“…Other researchers have suggested that TAVI performed under sedation results in better control of hemodynamic status, shorter procedural time, and shorter overall length of stay in hospital when compared with general anesthesia (Dehédin et al, 2011). According to our results with elderly Chinese patients, sedation with local anesthesia had several advantages over general anesthesia for transfemoral TAVI.…”

Section: Bis-guided Sedation Vs General Anesthesiasupporting

confidence: 49%

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: 49%

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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“…The length of critical care unit stay and hospital stay (days) were 5.64±2.99 and 11.92±5.54, respectively in this study. Different periods for critical care unit stay and hospital stay were reported by Bergmann et al [19] and Dehedin et al [12] [(4.6±7.4, 15.4±14.2); (2±4, 7±14.5), respectively]. These differences may be caused by the clinical and demographic characteristics of the patients in the study groups.…”

Section: Discussionmentioning

confidence: 72%

“…There are numerous studies including the results of TAVI applications in many countries [10][11][12][13][14]. However, there are a limited number of studies on TAVI procedure in Turkey [15][16][17].…”

Section: Discussionmentioning

confidence: 99%

“…Similar to our study, all approaches of TAVI were performed under general anaesthesia with fluoroscopic and TEE guidance in Guinot et al 's [6] study. However, Dehedin et al [12] analysed the data of the patients who underwent transfemoral TAVI with general or local/regional anaesthesia. They reported lower intraoperative requirement catecholamine and volume expansion, shorter procedure duration and shorter hospital stay in the local/regional anaesthesia group compared to general anaesthesia group.…”

Section: Discussionmentioning

confidence: 99%

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Transcatheter Aortic Valve Implantation: First Applications and Short Term Outcomes in Our Clinic

et al. 2015

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Objective: The objective of this study is to evaluate the first applications and short term outcomes of transcatheter aortic valve implantation (TAVI) in our clinic, which is a new technology for the patients with high risk for surgical aortic valve replacement (SAVR). Materials and Methods:Between January 2010 and December 2012, twenty five patients (16 males, 9 females; mean age 74.04±8.86 years) diagnosed with severe aortic stenosis, who were at high risk for surgery (EuroSCORE II: 5.58±4.20) and underwent TAVI in our clinic, were evaluated. The demographic and clinical characteristics of patients, anaesthetic management, complications during pre-and post-operative periods and the mortality rate in the first 30 days and six months were recorded.Results: Edwards SAPIEN Valve prostheses were implanted by transfemoral approach (percutaneously in 10 patients and surgically in 15 patients) in all patients. The TAVI procedure was performed under general anaesthesia. The success rate of the TAVI procedure was 100%. Three patients had limited dissection of the femoral artery; however, intervention was not needed due to good distal perfusion rate. Permanent pacemaker was implanted to four patients because of long-term atrioventricular blockage. After the procedure, all patients were transferred to the Intensive Care Unit (ICU) and all patients were extubated in the ICU. The mean mechanical ventilation duration (minutes) was 166.20±39.32, the mean critical care unit stay (day) was 5.64±2.99 and the mean hospital stay (day) was 11.92±5.54. Acute renal failure was observed in one patient and stroke was observed in two patients on the first postoperative day. The mortality rate in the first 30 days and 6 months was found to be 4% and 16%, respectively. Conclusion:Transcatheter aortic valve implantation is a great option for patients with severe aortic stenosis who are at high risk for SAVR. In our institute, procedural success and short term outcomes for patients underwent TAVI were found to be similar to the other studies in the national and international literature. Bulgular: Tüm hastalarda Edwards SAPIEN Valve protez transfemoral yaklaşımla (10 hastada perkutanöz, 15 hastada cerrahi yöntemle) yerleştirildi. Tüm hastalarda TAVI işlemi genel anestezi altında yapıldı ve transözefagial ekokardiyografi tüm hastalara uygulandı. TAVI işleminin başarı oranı %100 idi. İşlem süresince mortalite ve ciddi komplikasyon izlenmedi. Üç hastada femoral arterde sınırlı disseksiyon görüldü, ancak distal perfüzyonun iyi olması nedeniyle herhangi bir müdahale gerekmedi. Uzun süreli atriyoventriküler blokaj nedeniyle dört hastaya kalıcı pacemaker takıldı. İşlem sonrası, tüm hastalar Yoğun Bakım Ünitesi'ne (YBÜ) gönderildi ve tüm hastalar YBÜ'de ekstübe edildi. Ortalama mekanik ventilasyon süresi (dakika): 166,20±39,32, ortalama yoğun bakımda kalış süresi (gün): 5,64±2,99 ve ortalama hastanede kalış süresi (gün): 11,92 ±5,54 idi. Postoperatif birinci gün, bir hastada akut renal yetmezlik ve iki hastada inme izlendi. İlk 30 gündeki mo...

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“…Many studies indicate that fast-track GA management is the most appropriate and safest anesthesia technique for any of the transfemoral, transapical, and transaxillary approaches (15,(17)(18)(19). There are only a few studies comparing the anesthetic techniques used in patients undergoing TAVI (16,20,21). In the first report, decreased ICU stay and faster hospital discharge were reported in patients undergoing sedation (22).…”

Section: Discussionmentioning

confidence: 99%

Anesthetic management and perioperative complications in transcatheter aortic valve implantation: the Turkish experience

Gümüş¹,

Kesimci²,

Soykut³

et al. 2014

Turk J Med Sci

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Anesthesia and Perioperative Management of Patients Who Undergo Transfemoral Transcatheter Aortic Valve Implantation: An Observational Study of General Versus Local/Regional Anesthesia in 125 Consecutive Patients

Cited by 115 publications

References 26 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

Transcatheter Aortic Valve Implantation: First Applications and Short Term Outcomes in Our Clinic

Anesthetic management and perioperative complications in transcatheter aortic valve implantation: the Turkish experience

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