Effect of thoracic epidural analgesia on clinical outcomes following transapical transcatheter aortic valve implantation.
OBJECTIVE
To determine the impact of perioperative thoracic epidural analgesia (TEA) on acute and late outcomes following transapical transcatheter aortic valve implantation (TA-TAVI).


METHODS
A total of 135 consecutive patients who underwent TA-TAVI were included. All patients received catheter-based pain control, either via TEA (TEA group, n=74) or intercostal local analgesia with a catheter placed at the surgical incision site (non-TEA group, n=61), depending on the preference of the anaesthesiologist responsible for the case.


METHODS
Pain level during early postoperative period (verbal rating scale from 1 to 10), 30-day/in-hospital complications and mortality, and 1-year mortality.


RESULTS
There were no differences in baseline or procedural characteristics between groups except for a lower left ventricular ejection fraction in the TEA group. The maximal pain score related to thoracotomy in the postoperative period was higher in the non-TEA group as compared with the TEA group (4 (IQR: 3-5)) vs 2 (IQR: 1-3), p<0.001). Non-TEA was associated with a higher rate of pulmonary complications (p<0.05 for nosocomial pneumonia, reintubation and tracheostomy). The 30-day/in-hospital mortality rate was higher in the non-TEA group (22.9% vs 2.7% in the TEA group, p<0.001). At 1-year follow-up, overall mortality remained higher in the non-TEA group (31.1%) compared with the TEA group (10.8%), p=0.005. Similar periprocedural and late results were obtained in a propensity score-matched analysis that included 100 matched patients. In the multivariable analysis, STS score (p=0.027) and absence of TEA (p=0.039) were independent predictors of increased cumulative late mortality.


CONCLUSIONS
TEA provided superior analgesia following TA-TAVI, and was associated with a dramatic reduction in periprocedural respiratory complications, and both, short- and long-term mortality. These results highlight the importance of obtaining optimal analgesia following TA-TAVI to improve the results associated with this procedure.
Quebec Heart Lung Institute, Laval University, Quebec City, Canada.
Ignacio J
IJ
Amat-Santos
Eric
E
Dumont
Jacques
J
Villeneuve
Daniel
D
Doyle
Michel
M
Rheault
Dominique
D
Lavigne
Jerôme
J
Lemieux
André
A
St-Pierre
Michael
M
Mok
Marina
M
Urena
Luis
L
Nombela-Franco
Steve
S
Blackburn
Mathieu
M
Simon
Christine
C
Bourgault
José Luis
JL
Carrasco
Philippe
P
Pibarot
Melanie
M
Côté
Robert
R
Delarochellière
David J
DJ
Cohen
Josep
J
Rodés-Cabau
D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome