Mid-term survival after transcatheter aortic valve implantation: Results with respect to the anesthetic management and to the access route (transfemoral versus transapical)

Abstract

Context:Several studies have analyzed the long-term survival after transcatheter aortic valve implantation (TAVI). However, no previous studies have looked at survival beyond 1-year with respect to the type of anesthesia.Aims:The aim was to evaluate the mid-term survival after TAVI with respect to the type of anesthesia (general anesthesia [GA] vs. local anesthesia ± sedation [LASedation]) or the type of procedure (transfemoral [transfem] vs. transapical TAVI) performed.Settings and Design:Retrospective cohort study.Subjects and Methods:This retrospective study included TAVI's between January 2009 and June 2013. Patients were divided into three groups: transfem TAVI under GA, transfem TAVI under LASedation and transapical TAVI. A total of 176 patients were eligible. The following clinical outcomes were evaluated: (1) Mortality, (2) Major cardiovascular complications, (3) Conduction abnormalities and arrhythmias, (4) Acute kidney injury, (5) Aortic regurgitation, (6) Neurologic events, (7) Vascular complications, (8) Pulmonary complications, (9) Bleeding, (10) Infectious complications, (11) Delirium.Statistical Analysis Used:A Kruskal–Wallis test was performed to test significance between the three groups for quantitative variables. Categorical variables were compared using a Chi-square test. Survival was estimated using Kaplan–Meier method.Results:There was no statistically significant difference between the survival of both transfem TAVI's (P = 0.46). The short-term outcome of the transfem TAVI groups was better than the transapical arm, but their mid-term survival did not show any significant difference (P = 0.69 transapical vs. transfem GA; P = 0.07 transapical vs. transfem LASedation).Conclusions:Our results demonstrate that the type of anesthesia and the access route do not influence mid-term survival after TAVI.

Is local anaesthesia a favourable approach for transcatheter aortic valve implantation? A systematic review and meta-analysis comparing local and general anaesthesia

“…43 44 Gauthier et al reported a lower risk of infectious complications for patients who received LAS for TAVI: they attributed this finding to the avoidance of bladder catheterisation, central venous catheter insertion and intubation. 28 Nevertheless, we could not identify a significant difference in the pneumonia rate between the LAS and GA groups, possibly because of the small number of studies that reported this outcome. Palermo et al described pneumonia rates of 0% for LAS versus 4.8% for GA; Covello et al reported rates of 0% for LAS versus 7% for GA; and Goren et al also found a lower incidence, with 2% for LAS versus 5% for GA.…”

“…We reviewed 35 full-text articles and identified 20 articles for inclusion in our review (figure 1). [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] All the studies were observational studies except one RCT. 32 Table 1 shows the baseline clinical characteristics of the included studies.…”

Postoperative Delirium in Individuals Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and Meta‐Analysis

“…The majority of participants included in our meta‐analysis were derived from 2 large prospective registries, with the lack of information regarding delirium diagnostic criteria and timing of the delirium screening . Interestingly, while these 2 large studies reported lower incidence of IHPOD after TAVR (e.g., 3.8% and 4.6%), small studies included in our analysis report higher incidence of IHPOD after TAVR . Several participant‐ and procedural‐related factors, including age at admission, comorbid condition, TAVR access, and hospital complication rate, could explain the differences in the incidence of IHPOD between these studies.…”

“…When inclusion and exclusion criteria were applied, 31 publications remained for assessment. 6,8,9,11,17, Most included studies were observational (14 prospective, 6,17,23,[26][27][28][29][30]33,35,37,41,44,47 6 propensity matched, 22,24,25,36,40,42 10 retrospective 8,9,11,31,32,34,38,43,45,46 ), with only one randomized controlled trial. 39 Differences in the differential diagnosis between POD and other comparable cognitive disorders, including dementia, depression, and schizophrenia, are summarized in Table 1.…”

“…29,45 Interestingly, while these 2 large studies reported lower incidence of IHPOD after TAVR (e.g., 3.8% and 4.6%), small studies included in our analysis report higher incidence of IHPOD after TAVR. 6,8,9,11,17,[22][23][24][25][26][27][28][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44]46,47 Several participant-and procedural-related factors, including age at admission, comorbid condition, TAVR access, and hospital complication rate, could explain the differences in the incidence of IHPOD between these studies. Larger studies are needed to identify clinical and procedural predictors of change in cognitive status early after TAVR, and to evaluate nonpharmacological strategies to reduce the incidence of IHPOD after TAVR.…”