Comparison of sedation and general anaesthesia for transcatheter aortic valve implantation on cerebral oxygen saturation and neurocognitive outcome

Transcatheter Aortic Valve Implantation (TAVI) has emerged over the last decade and has become a viable treatment option for those with severe symptomatic aortic stenosis (AS). The numbers of TAVI that are being performed in centres across the world is rising rapidly, and revolutionising treatment for AS and steering away from the need for open heart surgery. TAVI has been targeted for those who are deemed high risk to undergo open heart surgery such as the elderly, frail, or those with multiple co-morbidities. General anaesthesia (GA) has been used to facilitate TAVI especially when the procedure was in its infancy. The use of GA comes with its own set of risks such as haemodynamic compromise, risk for aspiration, longer procedure time and post-operative nausea and vomiting. These side effects and or complications may not be tolerated well in those who are elderly or have numerous co-morbidities. This article seeks to understand the outcomes of patients who undergo TAVI with the support of sedation and local anaesthesia (LA) in comparison to those who received GA.

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Comparison of general anaesthesia and non-general anaesthesia approach in transfemoral transcatheter aortic valve implantation

Heart ◽

10.1136/heartjnl-2017-312559 ◽

2018 ◽

Vol 104 (19) ◽

pp. 1621-1628 ◽

Cited By ~ 12

Author(s):

Mehdi Eskandari ◽

Omar Aldalati ◽

Rafal Dworakowski ◽

Jonathan A Byrne ◽

Emma Alcock ◽

...

Keyword(s):

Aortic Valve ◽

Length Of Stay ◽

General Anaesthesia ◽

Transcatheter Aortic Valve Implantation ◽

Transcatheter Aortic Valve ◽

Significant Difference ◽

Aortic Valve Implantation ◽

The Uk ◽

Valve Implantation ◽

The Impact

ObjectivePerforming transfemoral transcatheter aortic valve implantation (TAVI) without general anaesthesia (GA) has been increasingly adopted. We sought to study the impact of GA and non-GA approaches on procedural outcome and 30-day and 1-year mortality in transfemoral TAVI.MethodsThe UK TAVI registry holds information for every TAVI procedure in the UK. We analysed the data for patients implanted during 2013–2014 using either an Edwards Sapien or a Medtronic CoreValve prosthesis. Propensity score-matching analysis was performed to adjust for confounding factors.Results2243 patients were studied (aged 81.4±7.5 years, 1195 males). 1816 (81%) underwent TAVI with GA and 427 (19%) without GA. Transoesophageal echocardiography (TOE) was used in 92.3% of GA and 12.4% of non-GA cases (p<0.001). There was no significant difference in the rate of successful valve deployment (GA 97.2% vs non-GA 95.7%, p=0.104) and in the incidence of more than mild aortic regurgitation (AR) at the end of the procedure (GA 5.6% vs non-GA 7.0%, p=0.295). However, procedure time was longer (131±60 vs 121±60mins, p=0.002) and length of stay was greater (8.0±13.5 vs 5.7±5.5 days, p<0.001) for GA cases. 30-day and 1-year mortality rates did not differ between the GA and non-GA cases. After propensity matching, these results remained unchanged. A second propensity analysis (adjusted for mode of anaesthesia) did not show an association between use of TOE and rate of successful valve deployment or frequency of significant AR. Neither was TOE associated with a longer procedural time or greater length of stay.ConclusionProcedure outcome, and 30-day and 1-year mortality are not influenced by mode of anaesthesia. However, GA is associated with longer procedure duration and greater length of stay.

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P1792Delirium after transcatheter aortic valve implantation (TAVI) under general anaesthesia: incidence, predictors and relation to long-term survival

European Heart Journal ◽

10.1093/eurheartj/ehz748.0544 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

K Van Der Wulp ◽

M H Van Wely ◽

L Van Heijningen ◽

B M A Van Bakel ◽

Y Schoon ◽

...

Keyword(s):

Aortic Valve ◽

General Anaesthesia ◽

Transcatheter Aortic Valve Implantation ◽

Term Survival ◽

Long Term Survival ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation ◽

Long Term Mortality

Abstract Background Patients undergoing Transcatheter Aortic Valve Implantation (TAVI) are at risk of postoperative delirium (POD). Prospectively collected data on delirium after TAVI are scarce. Purpose Aim of this study is to report the incidence and risk factors of POD after TAVI under general anaesthesia. Also we assessed the relation of POD with clinical outcome and short- and long-term survival. Methods POD was assessed prospectively in all consecutive patients treated with TAVI in our centre between 2008 and 2017, according to the Diagnostic and Statistical Manual of Mental Disorder (DSM)-IV criteria. TAVI was performed under general anaesthesia in all patients. Outcome was reported according to the updated VARC2-criteria. Survival status was checked by consulting the Municipal Civil Registries. Results POD was observed in 16.5% (116/703) of all patients. Stroke and new onset of atrial fibrillation were more often observed in patients with POD (6.9% vs. 1.9%, p=0.007 and 12.1% vs. 5.1%, p=0.005, respectively). Independent preoperative predictors of POD were prior delirium (OR 2.56 [95% CI: 1.52–4.31], p<0.001), aortic valve area (AVA)<0.75 cm2 (OR 2.39 [1.53–3.74], p<0.001), age (1.08 [1.04–1.12], p<0.001) and BMI (0.94 [0.90–0.99], p=0.018). POD was the strongest independent predictor of long-term mortality (HR 1.91 [1.36–2.70], p<0.001) and was associated with impaired 30-day survival (92.2% vs. 96.8%, p=0.034) as well as 5-year survival (40.0% vs. 50.0%, p<0.001). Survival: Delirium vs No Delirium Conclusion One-in-six patients suffered from POD after TAVI under general anaesthesia. Prior delirium and more calcified aortic valve were the strongest independent predictors of POD. POD was the strongest predictor of long-term mortality and was associated with impaired short- as well as long-term survival.

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