Clinical Outcomes and Safety of Transfemoral Aortic Valve Implantation Under General Versus Local Anesthesia Subanalysis of the French Aortic National CoreValve and Edwards 2 Registry

作者：Oguri Atsushi; Yamamoto Masanori^*; Mouillet Gauthier; Gilard Martine; Laskar Marc; Eltchaninoff Helene; Fajadet Jean; Iung Bernard; Donzeau Gouge Patrick; Leprince Pascal; Leguerrier Alain; Prat Alain; Lievre Michel; Chevreul Karine; Dubois Rande Jean Luc; Chopard Romain; Van Belle Eric; Otsuka Toshiaki; Teiger Emmanuel

来源：Circulation: Cardiovascular Interventions , 2014, 7(4): 602-610.

DOI：10.1161/CIRCINTERVENTIONS.113.000403

• anesthesia, general
• anesthesia, local

Background-Transcatheter aortic valve implantation (TAVI) performed under local anesthesia (LA) is becoming increasingly common. We aimed to compare the clinical outcomes in patients who underwent transfemoral-TAVI under general anesthesia (GA) and LA. %26lt;br%26gt;Methods and Results-Data from 2326 patients in the French Aortic National CoreValve and Edwards 2 (FRANCE 2) registry who underwent transfemoral-TAVI were analyzed. During the study period, the percentage of LA procedures increased gradually from 14% in January 2010 to 59% in October 2011. The clinical outcomes for GA (n=1377) and LA (n=949) were compared. Numerous baseline characteristics differed between the 2 groups, and the use of transesophageal echocardiographic guidance was more common in GA than in LA (76.3% versus 16.9%; P%26lt;0.001). Device success and cumulative 30-day survival rates were similar in the 2 groups (97.6% versus 97.0%; P=0.41 and 91.6% versus 91.3%; P=0.69, respectively), whereas the incidence of postprocedural aortic regurgitation %26gt;= mild was significantly lower in GA than in LA (15.0% versus 19.1%; P=0.015). The groups were also analyzed using a propensity-matching model, including transesophageal echocardiographic usage (GA [n=401] versus LA [n=401]). This model indicated that there were no significant differences between the 2 groups in the rates of 30-day survival (GA [91.4%] versus LA [89.3%]; P=0.27] and postprocedural aortic regurgitation=mild (GA [12.7%] versus LA [16.2%]; P=0.19). %26lt;br%26gt;Conclusions-The less invasive transfemoral-TAVI under LA is preferred in clinical settings and seems to be acceptable; however, the higher incidence of postprocedural aortic regurgitation is emphasized. Therapeutic efforts should be made to reduce such complications during transfemoral-TAVI under LA.

• 出版日期2014-8