Abstract
Vessel Plus is an open acccess journal, which publishes articles related to vascular diseases, including acute respiratory distress syndrome, aneurysm, atherosclerosis, hypertension, stroke, peripheral vascular or pulmonary vascular diseases, etc.
Highlights
The volume of transcatheter aortic valve implantation (TAVI) has surpassed surgical aortic valve replacement in Europe and North America . [1,2,3] Traditionally, TAVI uses general anesthesia (GA) accompanied by intraprocedural transesophageal echocardiography (TEE) to assess root geometry and guide valve placement during the procedure[4]
The rate of any paravalvular leaks (PVL) was not significantly different between transthoracic echocardiography (TTE)-TAVI and TEE-TAVI groups (18.4% vs. 21.4%, risk ratio: 1.01, 95%CI: 0.83 to 1.23, P = 0.92, I2 = 36%)
Resource utilization was lower with TTE-TAVI; hospital length of stay (LOS) [mean difference (MD): -1.55 days, 95%CI: -2.27 to -0.83, P < 0.01], contrast volume (MD: -24.75 mL, 95%CI: -49.48 to -0.03, P = 0.05) and procedure time (MD: -31.09 min, 95%CI: -54.77 to -7.40, P < 0.01) were significantly lower
Summary
The volume of transcatheter aortic valve implantation (TAVI) has surpassed surgical aortic valve replacement in Europe and North America . [1,2,3] Traditionally, TAVI uses general anesthesia (GA) accompanied by intraprocedural transesophageal echocardiography (TEE) to assess root geometry and guide valve placement during the procedure[4]. Minimalist TAVI conducted under monitored anesthesia care (MAC) has gained popularity. Studies suggest that it is less invasive and allows for earlier mobilization and patient discharge without compromising early outcomes[6]. Since TEE is not usually conducted under MAC, minimalist TAVI often uses transthoracic echocardiography (TTE) instead[5]. Studies have shown that PVL after TAVI is often poorly tolerated and associated with excess late mortality[8,9]. Understanding whether PVL increases in patients undergoing TAVI with TTE compared to TEE is paramount. There are few studies directly comparing TTE and TEE in TAVI and the sample size in these studies are limited. There are many studies that compare usage of MAC and GA in TAVI[6]. Since TTE and TEE usage is closely associated with the mode of anesthesia, MAC and GA can be used as surrogate variables for TTE and TEE respectively
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