Complications after transcatheter aortic valve implantation using transfemoral and transapical approach in general anaesthesia

Abstract

BackgroundTranscatheter aortic valve implantation (TAVI) is a minimally invasive procedure used to treat degenerative heart valve disease. The implantation requires a highly specific and interdisciplinary management approach. Currently, TAVI is performed with the patient under local or general anaesthesia.MethodsThis study was a retrospective analysis of all TAVI procedures performed at the University Hospital of Regensburg between January 2009 and July 2015. All pre-, intra and postoperative data focusing on perioperative complications were recorded.ResultsA total of 853 transfemoral- and transapical-TAVI patients were included in the study. All patients underwent general anaesthesia. The ASA classifications were primarily 3–4. The average logistic EuroScores for the transfemoral- and transapical-TAVI patients were 18 ± 12% and 21 ± 15% (p = 0.002), respectively. The anaesthesia coverage time was 170 ± 49 min., including 37 ± 12 minutes for anaesthetic management. Overall, 458 complications were recorded; with pneumonia, acute renal failure, indication for a permanent pacemaker and non-extubation in the operating theatre the most frequently recorded complications.ConclusionIn the present study, we showed that our patients’ outcomes are comparable to those reported in the available literature. Compared to TF, TA patients show an overall worse physical condition as well as a higher perioperative morbidity and mortality. Consequently TA patients need additional care and should only be operated in appropriately experienced medical centres.

Anaesthesia-related complications and side-effects in TAVI: a retrospective study in Germany

“…Furthermore, better operative techniques could reduce complication rates and improve patient outcome. Additionally, other reasons (eg, emergency TAVI, diagnostic related groups (DRG) system, different standard operating procedures on the ICU) might have influenced ICU, IMC and hospital stay 13. Complications and side effects seen in this study might not be totally attributable to anaesthesia.…”

“…CoreValve (CoreValve Revalving System, Medtronic, Minneapolis, USA) was used in 16% of the cases (n=134). In the rest of the cases (n=80), the valve type could not be gathered from our sources 13…”

“…In this study, after obtaining the consent of the University of Regensburg’s Ethics Commission, all data from each TAVI procedure performed at the University Hospital Regensburg between January 2009 and July 2015 were retrospectively obtained and analysed for anaesthesia-related complications and anaesthesia-related side effects. Some data (eg, procedural time, intervention related complications, acute kidney injury) have already been presented elsewhere 13…”

“…Demographic data, such as age, sex, body mass index (BMI), ASA, New York Heart Association Functional Classification, European System for Cardiac Operative Risk Evaluation (EuroSCORE), anaesthesia-related parameters, side effects, complications and risk scores, clinical characteristics and recent illness, were obtained 14 15. Vital sign measurements (ie, heart rate, blood pressure and SpO 2 ) at defined times, as well as drugs administered throughout the TAVI procedure and in the ICU (first 12 hours), were acquired 13…”

“…After the intervention, the patients were immediately transferred to one of our three ICUs for monitoring. Depending on their physical condition, they were taken to the general ward or an IMC afterwards 13…”