title: Anesthesia and perioperative management of patients who undergo transfemoral transcatheter aortic valve implantation: an observational study of general versus local/regional anesthesia in 125 consecutive patients.
abstract: OBJECTIVE
  To describe differences in intra- and postoperative care between general (GA) and local/regional anesthesia (LRA) in consecutive high-risk patients with aortic stenosis who underwent transfemoral transcatheter aortic valve implantation (TAVI).
  
  
  METHODS
  A retrospective review of data collected in an institutional registry.
  
  
  METHODS
  An academic hospital.
  
  
  METHODS
  One hundred twenty-five consecutive patients with severe aortic stenosis who underwent transfemoral TAVI.
  
  
  METHODS
  GA versus LRA followed by postoperative care. Complications were defined by pre-established criteria.
  
  
  METHODS
  Consecutive patients referred for transfemoral TAVI between October 2006 and October 2010 initially underwent GA (n = 91) followed by LRA after March 2010 (n= 34). Results are presented as mean ± standard deviation or median (25-75 percentiles) as appropriate. GA and LRA TAVI patients had similar preoperative characteristics. LRA was associated with a significantly shorter procedure duration (LRA: 80 [67-102]; GA: 120 [90-140 minutes]; p < 0.001), hospital stay (LRA: 8.5 [7-14.5]; GA: 15.5 [10-24] days; p < 0.001), intraoperative requirements of catecholamines (LRA 23%; GA: 90% of patients; p < 0.001), and volume expansion (LRA: 11 [8-16]; GA: 22 [15-36] mL/kg; p < 0.001). There were significant differences in delta creatinine (day 1, preoperative creatinine values; LRA: 0 [-12 to 9]; GA: -15 (-25 to 2.9) μmol, p < 0.004). The frequency of any postoperative complications was 38% (LRA) and 77% (GA) (p = 0.11). Thirty-day mortality was 7% (GA) and 9% (LRA) (p = 0.9).
  
  
  CONCLUSIONS
  This observational study suggests that LRA was associated with less intraoperative hemodynamic instability and significant shortening of the procedure and hospital stay. Changes in the anesthetic technique adapted to changes in TAVI interventional techniques and did not increase the rate of postoperative complications.
authors.affiliation: Department of Anesthesia and Intensive Care, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Dehédin
authors.forename: Pierre-Grégoire
authors.initials: PG
authors.lastname: Guinot
authors.forename: Hassan
authors.initials: H
authors.lastname: Ibrahim
authors.forename: Nicolas
authors.initials: N
authors.lastname: Allou
authors.forename: Sophie
authors.initials: S
authors.lastname: Provenchère
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Dilly
authors.forename: Alec
authors.initials: A
authors.lastname: Vahanian
authors.forename: Dominique
authors.initials: D
authors.lastname: Himbert
authors.forename: Eric
authors.initials: E
authors.lastname: Brochet
authors.forename: Costin
authors.initials: C
authors.lastname: Radu
authors.forename: Patrick
authors.initials: P
authors.lastname: Nataf
authors.forename: Philippe
authors.initials: P
authors.lastname: Montravers
authors.forename: Dan
authors.initials: D
authors.lastname: Longrois
authors.forename: Jean-Pol
authors.initials: JP
authors.lastname: Depoix
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000765:Anesthesia, Conduction / Q000009:adverse effects / Q000401:mortality; D000768:Anesthesia, General / Q000009:adverse effects / Q000401:mortality; D000772:Anesthesia, Local / Q000009:adverse effects / Q000401:mortality; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D002404:Catheterization; D002423:Cause of Death; D015331:Cohort Studies; D003422:Critical Care; D017548:Echocardiography, Transesophageal; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D019990:Perioperative Care / Q000379:methods*; D012189:Retrospective Studies; D016683:Supine Position; D016896:Treatment Outcome