Initial Experience of a TAVI Program: Analysis of the Anesthetic Decision and its Evolution

Authors

  • Ana Margarida Martins Serviço de Anestesiologia. Hospital de Santa Marta. Centro Hospitalar de Lisboa Central. Lisboa.
  • Maria Lurdes Castro Serviço de Anestesiologia. Hospital de Santa Marta. Centro Hospitalar de Lisboa Central. Lisboa.
  • Isabel Fragata Serviço de Anestesiologia. Hospital de Santa Marta. Centro Hospitalar de Lisboa Central. Lisboa.

DOI:

https://doi.org/10.20344/amp.10982

Keywords:

Anesthesia, General, Local, Heart Valve Prosthesis Implantation, Transcatheter Aortic Valve Replacement

Abstract

Introduction: Transcatheter aortic valve implantation is a less invasive option for aortic valve replacement. The number of transcatheter aortic valve implantations under local anesthesia with sedation has been increasing as the team’s experience increases and less invasive accesses are used. The aim of this study is to describe the evolution of the anesthetic technique in patients undergoing transcatheter aortic valve implantation at our center over the years, as which was compared.

Material and Methods: Retrospective study in 149 consecutive patients undergoing transcatheter aortic valve implantation in Hospital Santa Marta (January 2010 to December 2016). Data was collected from the periprocedural records of patients. Patients were stratified according to anesthetic technique.

Results: From our patients’ sample, 57.0% were female, with median age 82 [58 - 95] years. Most patients underwent general anesthesia (68.5%). In the local anesthesia with sedation group there was a shorter duration of the procedure (120; [60 - 285] vs 155 [30 - 360]) and a lower number of patients requiring administration of vasopressors (61.8% vs 28.3%) – p < 0.05. There were no differences regarding length of hospital stay (9 [4 - 59] vs 10 [3 - 87]), periprocedural complications (66.0% vs 72.5%), readmission rate (4.3% vs 3.9%) or 30-days (2.1% vs 4.9%) and 1-year mortality (6.4% vs 7.8%) – p > 0.05. There was an increasing number of transcatheter aortic valve implantations performed under local anesthesia with sedation over the years.

Discussion: The choice of anesthetic technique depends on the patient’s characteristics, experience and preference of the team.

Conclusion: Local anesthesia with sedation seems to be associated with similar results as general anesthesia. The increase in the number of transcatheter aortic valve implantations under local anesthesia with sedation seems to follow the trend of lower invasiveness of the procedure.

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Published

2019-02-28

How to Cite

1.
Martins AM, Castro ML, Fragata I. Initial Experience of a TAVI Program: Analysis of the Anesthetic Decision and its Evolution. Acta Med Port [Internet]. 2019 Feb. 28 [cited 2024 Apr. 25];32(2):126-32. Available from: https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/10982

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Original