Local and general anaesthesia do not influence outcome of transfemoral aortic valve implantation.

Dall'Ara, Gianni; Eltchaninoff, Helene; Moat, Neil; Laroche, Cécile; Goicolea, Javier; Ussia, Gian Paolo; Kala, Petr; Wenaweser, Peter Martin; Zembala, Marian; Nickenig, Georg; Snow, Thomas; Price, Susanna; Barrero, Eduardo Alegria; Estevez-Loureiro, Rodrigo; Iung, Bernard; Zamorano, José Luis; Schuler, Gerhard; Alfieri, Ottavio; Prendergast, Bernard; Ludman, Peter; ... (2014). Local and general anaesthesia do not influence outcome of transfemoral aortic valve implantation. International journal of cardiology, 177(2), pp. 448-454. Elsevier 10.1016/j.ijcard.2014.09.025

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BACKGROUND There is great variability for the type of anaesthesia used during TAVI, with no clear consensus coming from comparative studies or guidelines. We sought to detect regional differences in the anaesthetic management of patients undergoing transcatheter aortic valve implantation (TAVI) in Europe and to evaluate the relationship between type of anaesthesia and in-hospital and 1year outcome. METHODS Between January 2011 and May 2012 the Sentinel European TAVI Pilot Registry enrolled 2807 patients treated via a transfemoral approach using either local (LA-group, 1095 patients, 39%) or general anaesthesia (GA-group, 1712 patients, 61%). RESULTS A wide variation in LA use was evident amongst the 10 participating countries. The use of LA has increased over time (from a mean of 37.5% of procedures in the first year, to 57% in last 6months, p<0.01). MI, major stroke as well as in-hospital death rate (7.0% LA vs 5.3% GA, p=0.053) had a similar incidence between groups, confirmed in multivariate regression analysis after adjusting for confounders. Dividing our population in tertiles according to the Log-EuroSCORE we found similar mortality under LA, whilst mortality was higher in the highest risk tertile under GA. Survival at 1year, compared by Kaplan-Meier analysis, was similar between groups (log-rank: p=0.1505). CONCLUSIONS Selection of anaesthesia appears to be more influenced by national practice and operator preference than patient characteristics. In the absence of an observed difference in outcomes for either approach, there is no compelling argument to suggest that operators and centres should change their anaesthetic practice.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Wenaweser, Peter Martin and Windecker, Stephan

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0167-5273

Publisher:

Elsevier

Language:

English

Submitter:

Judith Liniger

Date Deposited:

05 May 2015 15:11

Last Modified:

28 Oct 2015 11:41

Publisher DOI:

10.1016/j.ijcard.2014.09.025

PubMed ID:

25443245

Uncontrolled Keywords:

Anaesthesia; Aortic valve stenosis; Outcome; Transcatheter aortic valve implantation

BORIS DOI:

10.7892/boris.61910

URI:

https://boris.unibe.ch/id/eprint/61910

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