Department of Internal Medicine II, Paracelsus Medical University Salzburg, Muellner Hauptstr. 48, 5020 Salzburg, Austria.
Clin Res Cardiol. 2012 Jan;101(1):45-53. doi: 10.1007/s00392-011-0362-8. Epub 2011 Sep 20.
Transcatheter aortic valve implantation (TAVI) represents a novel option for elderly with severe aortic valve stenosis who are denied surgical aortic valve replacement due to high perioperative risk. While transfemoral TAVI generally is being performed in general anesthesia (GA), TAVI under local anesthesia plus mild sedation (LAPS) might be an effective and safe alternative.
In a single-centre analysis, we assessed clinical data, preoperative risk scores (STS-Score), echocardiography, periprocedural data and labor costs in 74 patients undergoing transfemoral TAVI under GA (n = 33) and LAPS (n = 41).
Patients who underwent TAVI in LAPS presented significantly more often with pulmonary hypertension and impaired renal function, and tended to have a higher STS score and more severe symptoms (higher NYHA class) versus the GA group. There were no significant differences in procedure-related 30-day mortality or complications between groups. The peak systolic and mean central aortic pressure were significantly higher in the LAPS group, while at the same time these patients required significantly less often periprocedural adrenergic support. Intervention time was shorter in the LAPS group due to avoidance of surgical cut-down of the access site. Moreover, total procedure time was significantly shorter and labor costs were lower in the LAPS group. Patients who underwent TAVI in LAPS could be mobilized significantly earlier.
Our study indicates that TAVI under LAPS is as effective and safe as TAVI under GA. Furthermore, total procedure time, intervention time and labor costs could be reduced by LAPS. Mobilization of patients could be achieved earlier. We therefore consider LAPS to be favorable in patients undergoing transfemoral TAVI.
经导管主动脉瓣植入术（TAVI）为因围手术期风险高而被拒绝接受外科主动脉瓣置换的老年严重主动脉瓣狭窄患者提供了一种新的选择。虽然经股动脉 TAVI 通常在全身麻醉（GA）下进行，但局部麻醉加轻度镇静（LAPS）下的 TAVI 可能是一种有效且安全的替代方法。
在单中心分析中，我们评估了 74 例在 GA（n=33）和 LAPS（n=41）下行经股动脉 TAVI 的患者的临床数据、术前风险评分（STS 评分）、超声心动图、围手术期数据和劳动力成本。
与 GA 组相比，行 LAPS 下 TAVI 的患者更常患有肺动脉高压和肾功能不全，并且倾向于具有更高的 STS 评分和更严重的症状（更高的 NYHA 分级）。两组之间在与手术相关的 30 天死亡率或并发症方面无显著差异。LAPS 组的收缩期峰值和平均中心主动脉压明显较高，而同时这些患者需要的围手术期肾上腺素支持明显较少。由于避免了手术切口部位的切开，LAPS 组的介入时间更短。此外，LAPS 组的总手术时间明显更短，劳动力成本更低。行 LAPS 下 TAVI 的患者可以更早地活动。
我们的研究表明，LAPS 下的 TAVI 与 GA 下的 TAVI 一样有效且安全。此外，LAPS 可降低总手术时间、介入时间和劳动力成本。患者的活动能力可以更早地实现。因此，我们认为 LAPS 对接受经股动脉 TAVI 的患者有利。
