General Anesthesia or Conscious Sedation for Transfemoral Aortic Valve Replacement with the SAPIEN 3 Transcatheter Heart Valve
Neumann, Franz-Josef; Redwood, Simon; Abdel-Wahab, Mohamed; Lefèvre, Thierry; Frank, Derk; Eltchaninoff, Hélène; Caussin, Christophe; Stella, Pieter R; Hovorka, Tomas; Baumgartner, Helmut; Tarantini, Giuseppe; Wendler, Olaf; Treede, Hendrik
(2020) International Heart Journal, volume 61, issue 4, pp. 713 - 719
(Article)
Abstract
Differences in the benefits of conscious sedation (CS) and general anesthesia (GA) during transfemoral aortic valve implantation (TAVI) are unclear.We aimed to assess differences in procedural and clinical outcomes based on the type of anesthesia received during TAVI.We analyzed SOURCE 3 Registry data for patients who received the SAPIEN 3
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valve by type of anesthesia used during TAVI.Of the 1694 TAVI patients, 1027 received CS and 667 received GA. Patients were similar at baseline (81.5 years; Society of Thoracic Surgeons risk score 7.0). Compared with the GA group, the CS group had fewer intra-procedural transesophageal echocardiography (TEE) and post implantation dilatations performed, and less contrast medium was used. The CS group had significantly less kidney injury at 7 days post-procedure than the GA group (0.4% versus 1.5%, P = 0.014). Moderate paravalvular leaks (PVL) occurred more frequently in the CS group versus the GA group (2.2% versus 0.8%; P = 0.041). No severe PVL were reported. Median total hospital length of stay (LOS) after TAVI was 10 days in the CS group and 11 days in the GS group. At 30 days, all-cause death was 2.1% in CS and 1.7% in GS (P = 0.47), and myocardial infarction was 0.2% in CS and 0.1% in GS (P = 0.83).Our analyses found no significant major outcome differences between CS and GA during TAVI.
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Keywords: Aortic stenosis, Balloon-expandable transcatheter heart valve, SOURCE 3 Registry, Transcatheter Aortic Valve Replacement, Conscious Sedation/statistics & numerical data, Humans, Aged, 80 and over, Female, Male, Registries, Aged, Anesthesia, General/statistics & numerical data, Cardiology and Cardiovascular Medicine, Journal Article, Comparative Study
ISSN: 1349-2365
Publisher: International Heart Journal Association
Note: Funding Information: From the 1University Heart Centre Freiburg/Bad Krozingen, University of Freiburg, Bad Krozingen, Germany, 2King’s Health Partners, London, UK, 3Leipzig Heart Center, Leipzig, Germany, 4Institut Cardiovasculaire Paris Sud, Hopital privé Jacques Cartier, Massy, France, 5University Hospital, Schleswig-Holstein, Kiel and DZHK (German Center for Cardiovascular Research, Kiel/Lübeck/Hamburg), Germany, 6Department of Cardiology, Rouen University Hospital, FHU REMOD-VHF, F76000, Rouen, France, 7Institut Mutualiste Montsouris, Paris, France, 8University Medical Center, Utrecht, The Netherlands, 9Statistics Department, Edwards Lifesciences, Prague, Czech Republic, 10Department of Cardiology III, University Hospital, Adult Congenital & Valvular Heart Disease, Münster, Germany, 11Padova Hospital, Italy, 12King’s College Hospital, London, United Kingdom and 13University Heart Center, Hamburg, Germany. This study was funded by Edwards Lifesciences. Address for correspondence: Franz-Josef Neumann, MD, Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg/Bad Krozingen, Südring 15, 79189 Bad Krozingen, Germany. E-mail: franz-josef.neumann@universitaets-herzzentrum.de Received for publication October 23, 2019. Revised and accepted March 16, 2020. Released in advance online on J-STAGE July 18, 2020. doi: 10.1536/ihj.19-567 All rights reserved by the International Heart Journal Association. Publisher Copyright: © 2020, International Heart Journal Association. All rights reserved. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
(Peer reviewed)