Transcarotid Transcatheter Aortic Valve Replacement: General or Local Anesthesia

详细信息    查看全文

• 作者：Nicolas Debry ; MD^a ; Cé ; dric Delhaye ; MD^a ; Alexandre Azmoun ; MD^b ; Ramzi Ramadan ; MD^b ; Sahbi Fradi ; MD^b ; Philippe Brenot ; MD^b ; Arnaud Sudre ; MD^a ; Mouhamed Djahoum Moussa ; MD^a ; Didier Tchetche ; MD^c ; Said Ghostine ; MD^b ; Darren Mylotte ; MD^d ; Thomas Modine ; MD ; PhD^a ; ^{t1modine@yahoo.fr" class="auth_mail" title="E-mail the corresponding author}
• 关键词：aortic stenosis ; general anesthesia ; local anesthesia ; transcarotid access ; transcatheter aortic valve replacement
• 刊名：JACC: Cardiovascular Interventions
• 出版年：2016
• 出版时间：24 October 2016
• 年：2016
• 卷：9
• 期：20
• 页码：2113-2120
• 全文大小：571 K

文摘

The study sought to assess the safety and efficacy of a minimally invasive strategy (MIS) (local anesthesia and conscious sedation) compared to general anesthesia (GA) among the largest published cohort of patients undergoing transcarotid transcatheter aortic valve replacement (TAVR).

Background

Transcarotid TAVR has been shown to be feasible and safe. There is, however, no information pertaining to the mode anesthesia in these procedures.

Methods

Between 2009 and 2014, 174 patients underwent transcarotid TAVR at 2 French centers. All patients were unsuitable for transfemoral TAVR due to severe peripheral vascular disease. An MIS was undertaken in 29.8% (n = 52) and GA in 70.1% (n = 122). One-year clinical outcomes were available in all patients and were described according to the Valve Academic Research Consortium-2 consensus.

Results

Transcarotid vascular access and transcatheter valve deployment was successful in all cases. Thirty-day mortality was 7.4% (n = 13) and 1-year all-cause and cardiovascular mortality were 12.6% (n = 22) and 8.0% (n = 14), respectively. According to the type of anesthesia, there was no between group difference in 30-day mortality (GA 7.3% vs. MIS 7.6%; p = 0.94), 1-year mortality (GA 13.9% vs. MIS 9.6%; p = 0.43), 1-month clinical efficacy (GA 85.2% vs. MIS 94.2%; p = 0.09), and early safety (GA 77.8% vs. MIS 86.5%; p = 0.18). There were 10 (5.7%) periprocedural cerebrovascular events: 4 strokes (2.2%) and 6 transient ischemic attacks (3.4%) among those treated with GA. There was neither stroke nor transient ischemic attack in the MIS group (p < 0.001).

Conclusions

The transcarotid approach for TAVR is feasible using general or local anesthesia. A higher rate of perioperative strokes was observed with GA.