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General Anesthesia Versus Monitored Anesthesia Care for Transfemoral Transcatheter Aortic Valve Implantation: A Retrospective Study in a Single Belgian Referral Center

Tijdschriftbijdrage - Tijdschriftartikel

OBJECTIVE: The objective of this study was to compare the effect of general anesthesia (GA) versus monitored anesthesia care (MAC) on post-interventional outcomes in patients undergoing transfemoral transcatheter aortic valve implantation (TAVI). DESIGN: Retrospective before-after study using a quasi-experimental design. SETTING: University Hospitals Leuven, a single Belgian referral center. PARTICIPANTS: Patients undergoing transfemoral TAVI from March 1, 2014, to December 31, 2017, were included. INTERVENTIONS: GA was switched to MAC at the authors' institution for transfemoral TAVI in April 2016, and outcomes of patients who received GA were compared with those who received MAC. MEASUREMENTS AND MAIN RESULTS: The primary outcomes were length of stay in the intensive care unit and hospital. Secondary outcomes included standardized endpoints for TAVI trials as suggested by the Valve Academic Research Consortium, the incidence of vasopressor use, maximum dose of vasopressors, procedural time, and total anesthesia time. In the period studied, 178 patients underwent transfemoral TAVI (GA: n = 85; MAC: n = 93). Implementation of MAC was associated with a significant reduction in total length of hospital stay (7.6 [6.05-9.15] v 5.48 [4.58-6.38] d; p = 0.02); vasopressor requirements; and procedural and total anesthesia time. Length of intensive care unit stay and Valve Academic Research Consortium endpoints were not significantly different. CONCLUSIONS: In the authors' institution, implementation of MAC for patients undergoing transfemoral TAVI resulted in a significant reduction of hospital length of stay and increased operating room efficiency. Results could be confounded by increasing operator experience and improved implantation techniques.
Tijdschrift: Journal of Cardiothoracic and Vascular Anesthesia
ISSN: 1053-0770
Issue: 12
Volume: 33
Pagina's: 3283 - 3291
Aantal pagina's: 9
Jaar van publicatie:2019
Trefwoorden:Cardiovasculaire en respiratoire geneeskunde , Parageneeskundige wetenschappen