Anesthesia and Perioperative Management of Patients Who Undergo Transfemoral Transcatheter Aortic Valve Implantation: An Observational Study of General Versus Local/Regional Anesthesia in 125 Consecutive Patients

作者：Dehedin Benedicte; Guinot Pierre Gregoire; Ibrahim Hassan; Allou Nicolas; Provenchere Sophie; Dilly Marie Pierre; Vahanian Alec; Himbert Dominique; Brochet Eric; Radu Costin; Nataf Patrick; Montravers Philippe; Longrois Dan^*; Depoix Jean Pol

来源：Journal of Cardiothoracic and Vascular Anesthesia, 2011, 25(6): 1036-1043.

DOI：10.1053/j.jvca.2011.05.008

• aortic stenosis
• transcatheter aortic valve implantation
• anesthesia
• postoperative management
• complications

Objective: To describe differences in intra- and postoperative care between general (GA) and local/regional anesthesia (LRA) in consecutive high-risk patients with aortic stenosis who underwent transfemoral transcatheter aortic valve implantation (TAVI).
Design: A retrospective review of data collected in an institutional registry.
Setting: An academic hospital.
Participants: One hundred twenty-five consecutive patients with severe aortic stenosis who underwent transfemoral TAVI.
Interventions: GA versus LRA followed by postoperative care. Complications were defined by pre-established criteria.
Material and Methods: Consecutive patients referred for transfemoral TAVI between October 2006 and October 2010 initially underwent GA (n = 91) followed by LRA after March 2010 (n = 34). Results are presented as mean +/- standard deviation or median (25-75 percentiles) as appropriate. GA and LRA TAVI patients had similar preoperative characteristics. LRA was associated with a significantly shorter procedure duration [LRA: 80 [67-102]; GA: 120 [90-140 minutes]; p < 0.001), hospital stay (IRA: 8.5 [7-14.5]; GA: 15.5 [10-24] days; p < 0.001), intraoperative requirements of cat-echolamines (LRA 23%; GA: 90% of patients; p < 0.001), and volume expansion (LRA: 11(8-16]; GA: 22 [15-36] mL/kg; p < 0.001). There were significant differences in delta creatinine (day 1, preoperative creatinine values; LRA: 0 [-12 to 9]; GA: -15 (-25 to 2.9) mu mol, p < 0.004). The frequency of any postoperative complications was 38% (IRA) and 77% (GA) (p = 0.11). Thirty-day mortality was 7% (GA) and 9% (LRA) (p = 0.9).
Conclusions: This observational study suggests that LRA was associated with less intraoperative hemodynamic instability and significant shortening of the procedure and hospital stay. Changes in the anesthetic technique adapted to changes in TAVI interventional techniques and did not increase the rate of postoperative complications.

• 出版日期2011-12