Anesthetic Approaches in Transcatheter Aortic Valve Implantation Procedures

Abstract

Background: Transcatheter aortic valve implantation (TAVI) has emerged as an alternative to surgical aortic valve replacement in recent years and has become a popular treatment modality for inoperable or patients at high surgical risk with severe aortic stenosis. We aimed to evaluate our perioperative anesthetic experiences with patients undergoing TAVI under sedation or general anesthesia (GA). Methods: A total of 159 patients who underwent TAVI procedures between 2013 and 2018 were retrospectively investigated in our hospital. Demographic data, intraoperative anesthesia management, complications, and postoperative mortality rates were evaluated. Findings: One hundred fifty-nine patients, 58 males (36.5%) and 101 females (63.5%) with a mean age of 76.6±10.1 years, were included in the study. Of the 119 patients, (74.8%) underwent the procedure under sedation and 40 (25.2%) received GA. The duration of surgery and anesthesia was significantly longer in patients who received GA. The median length of intensive care unit stay was longer in the GA group (6 days vs. 9.5 days; p=0.047), but the frequency of intraoperative complications (0,8% vs. 1.0%; p=0.015), intraoperative hypotension (35.3% vs. 70%; p<0.001), and acute kidney injury (12.6% vs. 27.5%; p=0.028) was significantly higher in the GA group. Stroke occurred in seven patients and all were in the sedation group. In-hospital (1.7% vs. 10%; p=0.035) and all-cause mortality rates (35.3% vs. 52.5%; p=0.045) were higher in the GA group. Interpretation: Transcatheter aortic valve implantation procedures are a great option for patients with severe aortic stenosis who are at high risk for surgical repair. GA is related to increased procedure time, acute kidney injury, and mortality rates; therefore, local anesthesia and sedation should be the first option in suitable patients. This study is the first to demonstrate the relationship between GA and higher all-cause mortality rates during a median 36 months’ follow-up. Funding Statement: None to declare. Declaration of Interest: None to declare. Ethical Approval: This study was approved by the Hacettepe University Hospitals.