Conscious sedation versus general anesthesia for transcatheter aortic valve implantation in patients with severe chronic obstructive pulmonary disease

Perfusion ◽  
2021 ◽  
pp. 026765912110458
Author(s):  
Serkan Aslan ◽  
Ahmet Güner ◽  
Ali Rıza Demir ◽  
Emre Yılmaz ◽  
Ayşe Feyza Aslan ◽  
...  

Introduction: Chronic obstructive pulmonary disease (COPD) is considered a major risk factor for postoperative complications after transcatheter aortic valve implantation (TAVI). To date, there is no clear consensus on the best anesthesia management for these patients. We aimed to investigate the effects of types of anesthesia on clinical outcomes in patients with severe COPD undergoing TAVI. Methods: This is a single-center, retrospective study comparing conscious sedation (CS) versus general anesthesia (GA) in 72 patients with severe COPD who underwent TAVI. The primary endpoints were 30-day all-cause mortality and postoperative pulmonary complications. Results: The main outcome of interest of this study was that the frequency of pulmonary complications was statistically higher in the GA group (21.4% vs 3.3%, p = 0.038). These differences are most likely attributed to the GA because of prolonged mechanical ventilation, and longer ICU stay (2 (1.2–3) vs 2.5 (2–4) days, p = 0.029) associated with an increased risk of nosocomial infections. There were no significant differences in procedure complications and 30-day mortality between the two groups (GA; 19% vs CS; 13.3%, p = 0.521). One-year survival rates, compared by Kaplan-Meier analysis, were similar between groups (log-rank p = 0.733). Conclusion: In aortic stenosis patients with severe COPD undergoing TAVI, the use of GA compared with CS was associated with higher incidences of respiratory-related complications, and longer ICU length of stay. CS is a safe and viable option for these patients and should be considered the favored approach.

2016 ◽  
Vol 37 (9) ◽  
pp. 1094-1097 ◽  
Author(s):  
Yuhao Shi ◽  
Harindra C. Wijeysundera ◽  
Stephen E. Fremes ◽  
Andrew E. Simor

We identified risk factors for infection following transcatheter aortic valve implantation (TAVI); infection occurred in 35 (13.8%) of 253 patients. Variables associated with infection included chronic obstructive pulmonary disease (OR, 1.2; 95% CI, 1.1–1.4), postprocedural hemorrhage (OR, 1.2; 95% CI, 1.0–1.3), and procedure-related stroke (OR, 1.6; 95% CI, 1.3–2.1).Infect Control Hosp Epidemiol 2016;37:1094–1097


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