Sedation or general anesthesia for patients undergoing transcatheter aortic valve implantation--does it affect outcome? An observational single-center study.
Aortic stenosis is one of the most common valvular lesions. Nowadays, a new treatment is emerging: the transcatheter aortic valve implantation (TAVI). It is considered a suitable alternative for the surgical approach in selected high-risk patients. This procedure may be performed under sedation (SED) or under general anesthesia (GEA).


OBJECTIVE
Assess the feasibility and safety of TAVI under sedation.


METHODS
Observational study.


METHODS
Single-center study conducted between the years 2009 and 2012.


METHODS
A total of 204 American Society of Anesthesiologists physical status 3 to 4 patients who underwent TAVI in the study period and for whom complete data were obtained were included. Demographic and periprocedural data were acquired from the patients' files. The patients were divided into SED and GEA groups.


METHODS
The study was not an interventional study.


METHODS
The study did not include measurements.


RESULTS
The 2 groups had similar demographic characteristics and echocardiographic parameters. The rate of conversion from SED to GEA was 4.6%. The SED group received significantly less catecholamines and intravenous fluids during the procedure. The total procedural time was significantly shorter for the SED group. There was a trend toward more postprocedural pulmonary complications in the GEA group. In-hospital mortality and total length of stay were similar between the groups.


CONCLUSIONS
The results of the current study, which included a relatively large number of patients, suggest that both anesthetic modalities are safe for patients undergoing TAVI. The anesthesiologist should thus tailor the anesthetic approach to the patient, taking into account the team's experience as well as the hemodynamic status of the patient. With growing experience, our team recommends performing TAVI under SED and in selected cases under GEA.
Division of Anesthesiology, Pain, and Intensive Care, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel. Electronic address: goren.orr@gmail.com.
Or
O
Goren
Department of Cardiology, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.
Ariel
A
Finkelstein
Division of Anesthesiology, Pain, and Intensive Care, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.
Andrei
A
Gluch
Division of Anesthesiology, Pain, and Intensive Care, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.
Nechama
N
Sheinberg
Division of Anesthesiology, Pain, and Intensive Care, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.
Elia
E
Dery
Division of Anesthesiology, Pain, and Intensive Care, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.
Idit
I
Matot
D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000379:methods*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007902:Length of Stay; D008297:Male; D061646:Operative Time; D011446:Prospective Studies; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*
D006993:Hypnotics and Sedatives
Aortic stenosis; Sedation; Transcatheter aortic valve implantation