Anaesthesia for trans-aortic Transcatheter Aortic Valve Replacement (TAVI-ta – does single-lung ventilation have an impact?

Abstract

IntroductionTAVI-ta has become an alternative for selected patients and can be done by partial sternotomy or right-anterior mini thoracotomy (RAMT). Single-lung ventilation (SLV) may be necessary for RAMT. Isolation of the right lung may induce a shunt of about 50% and further lead to hypoxemia. We hypothesized that patients with SLV had a lower perioperative arterial partial pressure (PaO2). Furthermore we hypothetized that SLV-patients had a higher need of catecholaminergic therapy.MethodData for this pilot trial was retrieved from our prospective registry. We compared patients undergoing TAVI-ta in RAMT with and without SLV usage. Initiation and duration of SLV was at the discretion of the interventionalist. Arterial blood gas analysis (ABG) was analyzed before induction (room air), after induction (FiO2 1.0), 20 minute after initiation of SLV (or corresponding if SLV was not used) and on admission to ICU.ResultsBetween June 2008 and December 2014 62 patients underwent TAVI-ta. In 44/62 RAMT was chosen. SLV was used in 30/44 patients. Patient characteristics, ABG and catecholamine use are shown in the table. Median [IQR] ELV duration was 65 [30/85] min.DiscussionTabled 1no SLVSLVp-valuen= 14n=30Age (yrs)81 (78-86)82 (79-84)0.484EuroSCORE log (%)33.29 (20.07-42.53 )19.64 (15.76-35.30)0.300Euroscore II (%)10.14 (5.55-12.57)8.66 (3.46-12.95)0.441STS Mortality (%)10.16 (8.62-10.84)8.30 (3.79-18.00)0.447Ejection Fraction (%)35 (31-55)45 (30-60)0.320Aortic Valve Area (cm2)0.70 (0.60-0.86)0.60 (0.60-0.85)0.390Use of Caecholamines (n=)13 (92%)27 (90%)1.000Dosage Norepinephrine (mcg/kg)3.7 (2.2-7.0)7.1 (3.2-10.7)0.187Duration Anaesthesia (Min)215 (200-240)240 (208-278)0.046PaO2 before induction (mmHg)79 (69.9-88.5)74.5 (70.9-88.9)0.885PaCO2 before induction (mmHg)38 (37-40)36.6 (30.0-41.8)0.469PaO2 after induction (mmHg)337.6 (222.3-395.2)363.4 (340.9-413.1)0.422PaCO2 after induction (mmHg)45 (37.3-50.0)41 (36.6-46.9)0.454PaO2 during SLV (mmHg)219.3 (81.1-317.9)150.7 (111.6-301.9)0.865PaCO2 during SLV (mmHg)47.4 (42.3-55.4)45.6 (42.8-54.1)0.654PaO2 Admission ICU (mmHg)152.7 (115.8-202.2)118.9 (93.4-140.9)0.291PaCO2 Admission ICU (mmHg)41.5 (38.8-43.9)41.6 (35.8-46.8)0.928In-hospital mortality (n=)01 (3%)0.333Length of hospital stay (d)9 (8-17)11 (8-14)0.796 Open table in a new tab IntroductionTAVI-ta has become an alternative for selected patients and can be done by partial sternotomy or right-anterior mini thoracotomy (RAMT). Single-lung ventilation (SLV) may be necessary for RAMT. Isolation of the right lung may induce a shunt of about 50% and further lead to hypoxemia. We hypothesized that patients with SLV had a lower perioperative arterial partial pressure (PaO2). Furthermore we hypothetized that SLV-patients had a higher need of catecholaminergic therapy. TAVI-ta has become an alternative for selected patients and can be done by partial sternotomy or right-anterior mini thoracotomy (RAMT). Single-lung ventilation (SLV) may be necessary for RAMT. Isolation of the right lung may induce a shunt of about 50% and further lead to hypoxemia. We hypothesized that patients with SLV had a lower perioperative arterial partial pressure (PaO2). Furthermore we hypothetized that SLV-patients had a higher need of catecholaminergic therapy. MethodData for this pilot trial was retrieved from our prospective registry. We compared patients undergoing TAVI-ta in RAMT with and without SLV usage. Initiation and duration of SLV was at the discretion of the interventionalist. Arterial blood gas analysis (ABG) was analyzed before induction (room air), after induction (FiO2 1.0), 20 minute after initiation of SLV (or corresponding if SLV was not used) and on admission to ICU. Data for this pilot trial was retrieved from our prospective registry. We compared patients undergoing TAVI-ta in RAMT with and without SLV usage. Initiation and duration of SLV was at the discretion of the interventionalist. Arterial blood gas analysis (ABG) was analyzed before induction (room air), after induction (FiO2 1.0), 20 minute after initiation of SLV (or corresponding if SLV was not used) and on admission to ICU. ResultsBetween June 2008 and December 2014 62 patients underwent TAVI-ta. In 44/62 RAMT was chosen. SLV was used in 30/44 patients. Patient characteristics, ABG and catecholamine use are shown in the table. Median [IQR] ELV duration was 65 [30/85] min. Between June 2008 and December 2014 62 patients underwent TAVI-ta. In 44/62 RAMT was chosen. SLV was used in 30/44 patients. Patient characteristics, ABG and catecholamine use are shown in the table. Median [IQR] ELV duration was 65 [30/85] min. DiscussionTabled 1no SLVSLVp-valuen= 14n=30Age (yrs)81 (78-86)82 (79-84)0.484EuroSCORE log (%)33.29 (20.07-42.53 )19.64 (15.76-35.30)0.300Euroscore II (%)10.14 (5.55-12.57)8.66 (3.46-12.95)0.441STS Mortality (%)10.16 (8.62-10.84)8.30 (3.79-18.00)0.447Ejection Fraction (%)35 (31-55)45 (30-60)0.320Aortic Valve Area (cm2)0.70 (0.60-0.86)0.60 (0.60-0.85)0.390Use of Caecholamines (n=)13 (92%)27 (90%)1.000Dosage Norepinephrine (mcg/kg)3.7 (2.2-7.0)7.1 (3.2-10.7)0.187Duration Anaesthesia (Min)215 (200-240)240 (208-278)0.046PaO2 before induction (mmHg)79 (69.9-88.5)74.5 (70.9-88.9)0.885PaCO2 before induction (mmHg)38 (37-40)36.6 (30.0-41.8)0.469PaO2 after induction (mmHg)337.6 (222.3-395.2)363.4 (340.9-413.1)0.422PaCO2 after induction (mmHg)45 (37.3-50.0)41 (36.6-46.9)0.454PaO2 during SLV (mmHg)219.3 (81.1-317.9)150.7 (111.6-301.9)0.865PaCO2 during SLV (mmHg)47.4 (42.3-55.4)45.6 (42.8-54.1)0.654PaO2 Admission ICU (mmHg)152.7 (115.8-202.2)118.9 (93.4-140.9)0.291PaCO2 Admission ICU (mmHg)41.5 (38.8-43.9)41.6 (35.8-46.8)0.928In-hospital mortality (n=)01 (3%)0.333Length of hospital stay (d)9 (8-17)11 (8-14)0.796 Open table in a new tab