Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.06.017
Brazilian Journal of Anesthesiology
Original Investigation

Comparison of anesthesia management in transcatheter aortic valve implantation: a retrospective cohort study

Comparação do manejo da anestesia no implante de válvula aórtica transcateter: um estudo de coorte retrospectivo

Gönül Erkan, Buket Ozyaprak, Ferdane Aydoğdu Kaya, Ihsan Dursun, Levent Korkmaz

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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.

Keywords

Heart valve prosthesis;  Aortic stenosis;  Local anesthesia;  General anesthesia

Resumo

Justificativa e objetivos: Nosso objetivo foi investigar os efeitos de duas técnicas anestésicas diferentes em nossos pacientes submetidos ao implante de válvula aórtica transcateter (IVAT). Métodos: Neste estudo, foram avaliados retrospectivamente 303 pacientes submetidos ao procedimento de IVAT com diagnóstico de estenose aórtica grave entre 1º de janeiro de 2012 e 31 de dezembro de 2018. Os pacientes foram divididos de acordo com o tipo de anestesia administrada durante cada procedimento como; anestesia geral (AG), anestesia local (AL). Resultados: O AL foi preferido em 245 (80,8%) dos 303 pacientes submetidos ao IVAT, enquanto o AG foi preferido em 58 pacientes (19,1%). As idades medianas de nossos pacientes que receberam AL e AG foram 83 e 84, respectivamente. A duração do procedimento e da anestesia dos pacientes do grupo AG foi maior que do grupo AL (p0,05), exceto para doença arterial periférica. A hipertensão foi a comorbidade mais comum em ambos os grupos. Embora o número de uso de inotrópicos tenha sido significativamente maior nos pacientes que receberam AG (p0,05). Terapia intensiva e internações hospitalares foram significativamente menores no grupo AL (p = 0,001, p = 0,023, respectivamente). Conclusão: A técnica anestésica do procedimento IVAT não teve efeito significativo nos desfechos incluindo; complicações, mortalidade e sucesso do procedimento. AL proporciona menor duração do procedimento e internação hospitalar.

Palavras-chave

Prótese de válvula cardíaca; Estenose aortica; Anestesia local; Anestesia geral

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