Comparison of Deep Sedation With General Anesthesia in Patients Undergoing Percutaneous Mitral Valve Repair

Abstract

BackgroundPercutaneous edge‐to‐edge mitral valve repair (PMVR) has become an established treatment option for mitral regurgitation in patients not eligible for surgical repair. Currently, most procedures are performed under general anesthesia (GA). An increasing number of centers, however, are performing the procedure under deep sedation (DS). Here, we compared patients undergoing PMVR with GA or DS.Methods and ResultsA total of 271 consecutive patients underwent PMVR at our institution between May 2014 and December 2016. Seventy‐two procedures were performed under GA and 199 procedures under DS. We observed that in the DS group, doses of propofol (743±228 mg for GA versus 369±230 mg for DS, P<0.001) and norepinephrine (1.1±1.6 mg for GA versus 0.2±0.3 mg for DS, P<0.001) were significantly lower. Procedure time, fluoroscopy time, and dose area product were significantly higher in the GA group. There was no significant difference between GA and DS with respect to overall bleeding complications, postinterventional pneumonia (4% for GA versus 5% for DS), or C‐reactive protein levels (361±351 nmol/L for GA versus 278±239 nmol/L for DS). Significantly fewer patients with DS needed a postinterventional stay in the intensive care unit (96% for GA versus 19% for DS, P<0.001). Importantly, there was no significant difference between DS and GA regarding intrahospital or 6‐month mortality.Conclusions DS for PMVR is safe and feasible. No disadvantages with respect to procedural outcome or complications in comparison to GA were observed. Applying DS may simplify the PMVR procedure.

Impact of conscious sedation and general anesthesia on periprocedural outcomes in Watchman left atrial appendage closure

“…Conceptually, CS might be associated with an increased aspiration risk caused by hypersalivation due to the TEE probe. However, studies investigating GA and CS in patients undergoing percutaneous mitral valve repair observed no differences regarding the development of postoperative pneumonia, which is similar to our findings [4,6]. In those studies, the rate of postoperative pneumonia varied between 3.3% and 6.7%, which is comparable to the rate observed in the present study, in which all patients received peri-interventional prophylactic antibiotics according to the guidelines.…”

“…These observations are in line with other studies that investigated the impact of CS and GA on outcomes in other structural interventions such as percutaneous mitral valve repair or transcatheter aortic valve implantation (TAVI) [4][5][6][7][8][9][10]. Those studies report no differences in procedural success or clinical outcomes according to the type of anesthesia.…”

“…Individual patient characteristics such as biological and social status, the burden of comorbidities, quality of life, frailty, and anticipated residual lifespan should be considered when planning LAAC in elderly patients. With regard to postoperative monitoring, the standard protocol of the two centers required 4 hours for CS and 24 hours for GA. Other investigations documented consistently shorter IMC/ICU hours after CS only [4][5][6][7][8][9][10]. In addition, Toppen et al [7] reported a higher quality of life at 30day follow-up and a decrease in direct costs in patients, who received TAVI under CS.…”

“…The other is conscious sedation (CS) with the patient spontaneously breathing. Previous studies investigating the type of anesthesia used during other heart disease interventions could not establish superiority of any one method but documented shorter postoperative monitoring or length of hospital stay in CS [4][5][6][7][8][9][10]. Data on the impact of CS or GA on periprocedural outcomes in LAAC are lacking.…”

Conventional echocardiographic parameters or three-dimensional echocardiography to evaluate right ventricular function in percutaneous edge-to-edge mitral valve repair (PMVR)

“…was present in 13.3% of patients. Furthermore, peri-procedural settings such as the type of anesthesia and catecholamine doses (general anesthesia versus conscious sedation) [34] could influence RV Function. However, in our analysis, changes in RV function showed no difference between general anesthesia and conscious sedation.…”