Journal article
Local and general anaesthesia do not influence outcome of transfemoral aortic valve implantation.
- Dall'Ara G NIHR Cardiovascular BRU, Royal Brompton Hospital, London, United Kingdom.
- Eltchaninoff H University Hospital, Rouen, France.
- Moat N NIHR Cardiovascular BRU, Royal Brompton Hospital, London, United Kingdom.
- Laroche C EurObservational Reasearch Progamme Department, European Society of Cardiology, Sophia-Antipolis, France.
- Goicolea J Hospital Universita Puerta de Hierro, Madrid, Spain.
- Ussia GP University of Rome Tor Vergata, Rome, Italy.
- Kala P Masaryk University, University Hospital Brno, Brno, Czech Republic.
- Wenaweser P Bern University Hospital, Bern, Switzerland.
- Zembala M Silesian Centre for Heart Disease, Zabrze, Poland.
- Nickenig G University Hospital, Bonn, Germany.
- Snow T St. Thomas' Hospital, London, United Kingdom.
- Price S NIHR Cardiovascular BRU, Royal Brompton Hospital, London, United Kingdom.
- Barrero EA Hospital Universitario de Torrejon, Madrid, Spain.
- Estevez-Loureiro R Complejo Asistencial Universitario de Leon, Leon, Spain.
- Iung B Bichat Hospital, Paris, France.
- Zamorano JL Hospital Universitario Ramon y Cajall, Madrid, Spain.
- Schuler G Herzzentrum Leipzig Abt. Kardiologie und Angiologie, Leipzig, Germany.
- Alfieri O Ospedale San Raffaele, Milan, Italy.
- Prendergast B John Radcliffe Hospital, Oxford, United Kingdom.
- Ludman P Queen Elizabeth Hospital, Birmingham, United Kingdom.
- Windecker S Bern University Hospital, Bern, Switzerland.
- Sabate M Thorax Institute, Hospital Clinic, Barcelona, Spain.
- Gilard M Centre Hospitalier Universitaire (CHU) Brest, Brest, France.
- Witkowski A Institute of Cardiology, Warsaw, Poland.
- Danenberg H Hadassah-Hebrew University Medical Centre, Jerusalem, Israel.
- Schroeder E UCL de Mont-Godinne, Yvoir, Belgium.
- Romeo F University of Rome Tor Vergata, Rome, Italy.
- Macaya C Clinico 'San Carlos' University Hospital, Madrid, Spain.
- Derumeaux G University of Lyon, Lyon, France.
- Mattesini A NIHR Cardiovascular BRU, Royal Brompton Hospital, London, United Kingdom.
- Tavazzi L Maria Cecilia Hospital GVM Care & Research, Ettore Sansavini Health Science Foundation, Cotignola, Italy.
- Di Mario C NIHR Cardiovascular BRU, Royal Brompton Hospital, London, United Kingdom. Electronic address: c.dimario@rbht.nhs.uk.
- 2014-12-03
Published in:
- International journal of cardiology. - 2014
Anaesthesia
Aortic valve stenosis
Outcome
Transcatheter aortic valve implantation
Aged
Aged, 80 and over
Anesthesia, General
Anesthesia, Local
Aortic Valve Stenosis
Female
Humans
Male
Pilot Projects
Registries
Transcatheter Aortic Valve Replacement
Treatment Outcome
English
BACKGROUND
There is great variability for the type of anaesthesia used during TAVI, with no clear consensus coming from comparative studies or guidelines. We sought to detect regional differences in the anaesthetic management of patients undergoing transcatheter aortic valve implantation (TAVI) in Europe and to evaluate the relationship between type of anaesthesia and in-hospital and 1 year outcome.
METHODS
Between January 2011 and May 2012 the Sentinel European TAVI Pilot Registry enrolled 2807 patients treated via a transfemoral approach using either local (LA-group, 1095 patients, 39%) or general anaesthesia (GA-group, 1712 patients, 61%).
RESULTS
A wide variation in LA use was evident amongst the 10 participating countries. The use of LA has increased over time (from a mean of 37.5% of procedures in the first year, to 57% in last 6 months, p<0.01). MI, major stroke as well as in-hospital death rate (7.0% LA vs 5.3% GA, p=0.053) had a similar incidence between groups, confirmed in multivariate regression analysis after adjusting for confounders. Dividing our population in tertiles according to the Log-EuroSCORE we found similar mortality under LA, whilst mortality was higher in the highest risk tertile under GA. Survival at 1 year, compared by Kaplan-Meier analysis, was similar between groups (log-rank: p=0.1505).
CONCLUSIONS
Selection of anaesthesia appears to be more influenced by national practice and operator preference than patient characteristics. In the absence of an observed difference in outcomes for either approach, there is no compelling argument to suggest that operators and centres should change their anaesthetic practice.
There is great variability for the type of anaesthesia used during TAVI, with no clear consensus coming from comparative studies or guidelines. We sought to detect regional differences in the anaesthetic management of patients undergoing transcatheter aortic valve implantation (TAVI) in Europe and to evaluate the relationship between type of anaesthesia and in-hospital and 1 year outcome.
METHODS
Between January 2011 and May 2012 the Sentinel European TAVI Pilot Registry enrolled 2807 patients treated via a transfemoral approach using either local (LA-group, 1095 patients, 39%) or general anaesthesia (GA-group, 1712 patients, 61%).
RESULTS
A wide variation in LA use was evident amongst the 10 participating countries. The use of LA has increased over time (from a mean of 37.5% of procedures in the first year, to 57% in last 6 months, p<0.01). MI, major stroke as well as in-hospital death rate (7.0% LA vs 5.3% GA, p=0.053) had a similar incidence between groups, confirmed in multivariate regression analysis after adjusting for confounders. Dividing our population in tertiles according to the Log-EuroSCORE we found similar mortality under LA, whilst mortality was higher in the highest risk tertile under GA. Survival at 1 year, compared by Kaplan-Meier analysis, was similar between groups (log-rank: p=0.1505).
CONCLUSIONS
Selection of anaesthesia appears to be more influenced by national practice and operator preference than patient characteristics. In the absence of an observed difference in outcomes for either approach, there is no compelling argument to suggest that operators and centres should change their anaesthetic practice.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.ijcard.2014.09.025
- PMID 25443245
- Persistent URL
- https://sonar.ch/global/documents/80098
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