Abstract
Few studies to date have assessed the postoperative pulmonary complications after transcatheter aortic valve implantation (TAVI) according to the anesthesia method. The present study aims to compare the effects of general anesthesia (GA) or monitored anesthesia care (MAC) on postoperative outcomes in patients undergoing TAVI. This retrospective cohort study included 578 patients who underwent TAVI through the trans-femoral approach between August 2011 and May 2019 at a single tertiary academic center. The primary outcome was postoperative pulmonary complications, which were defined as the occurrence of one or more pulmonary complications, such as respiratory failure, respiratory infection, and radiologic findings, within 7 days after TAVI. Secondary outcomes included postoperative delirium, all-cause 30-day mortality rate, 30-day readmission rate, reoperation rate, vascular complications, permanent pacemaker/implantable cardioverter-defibrillator insertion, length of stay in the ICU, hospital stay, and incidence of stroke. Of the 589 patients, 171 underwent TAVI under general anesthesia (GA), and 418 under monitored anesthesia care (MAC). The incidence of postoperative pulmonary complications was significantly higher in the GA than in the MAC group (17.0% vs. 5.3%, p < 0.001). Anesthetic method significantly affected the occurrence of postoperative pulmonary complications, but not of delirium. ICU stay was significantly shorter in the MAC group, as were operation time, the volume of fluid administered during surgery, heparin dose, transfusion, and inotrope requirements. TAVI under MAC can increase the efficiency of medical resources, reducing the lengths of ICU stay and the occurrence of postoperative pulmonary complications, compared with TAVI under GA.
Highlights
Introduction published maps and institutional affilTranscatheter aortic valve implantation (TAVI) has become a treatment of choice for patients with severe symptomatic aortic valve stenosis at high surgical risk [1,2,3].In addition, transcatheter aortic valve implantation (TAVI) was recently shown to be a good alternative to surgery in patients at low surgical risk [4,5,6,7], suggesting that the number of patients undergoing TAVI for severe symptomatic aortic valve stenosis will increase
This study, which was performed according to the guidelines of the Declaration of Helsinki, was approved by the institutional review board (IRB) of Asan Medical Center (Seoul, Korea, approval number 2020-0838, approval date 27 May 2020, chairperson Professor Moo-Song Lee), which waived the requirement for informed consent due to the retrospective, anonymized nature of this study
The present study found that the anesthetic method in patients who underwent trans-femoral TAVI significantly affected the occurrence of pulmonary complications (PPCs), but not of postoperative delirium
Summary
Transcatheter aortic valve implantation (TAVI) has become a treatment of choice for patients with severe symptomatic aortic valve stenosis at high surgical risk [1,2,3]. TAVI was recently shown to be a good alternative to surgery in patients at low surgical risk [4,5,6,7], suggesting that the number of patients undergoing TAVI for severe symptomatic aortic valve stenosis will increase. When TAVI was first introduced, general anesthesia (GA) was preferred over monitored anesthesia care (MAC) because. GA facilitates more rapid surgical correction of various complications that were due to the lack of experience with the TAVI procedure.
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