Department of Cardiology, Chair of Cardiology, Medical University of Lodz, Lodz, Poland.
Kardiol Pol. 2018;76(2):406-412. doi: 10.5603/KP.a2017.0214. Epub 2017 Nov 13.
General anaesthesia may have negative impact on patient mortality and morbidity, as well as overall procedure costs, in atrial septal occluder (ASO) implantation.
We sought to evaluate the safety, efficacy, and feasibility of conscious sedation for transcatheter implantation of ASOs.
A total of 122 patients referred for transcatheter implantation of ASO were included. Mean patient age was 51 ± 15 years, and 43 (35%) patients were male. The initial dose of midazolam was 2 mg and fentanyl dose was 25 μg. Additional doses of midazolam and fentanyl were administered, if necessary. Patient responsiveness was assessed every 10 min, and the sedatives doses were titrated in order not to exceed grade 3 sedation in the Ramsey scale.
Atrial septal occluders were successfully implanted in the majority of patients (98.4%). In two (1.6%) cases the proce-dure failed because of too small patent foramen ovale (PFO) diameter (n = 1, 0.8%) or device instability (n = 1, 0.8%). The mean duration of procedure was 47.6 ± 28.4 min and was similar for ASD and PFO closure (p = 0.522). The overall mean dose of midazolam was 4.7 ± 2.2 mg (63.9 ± 32.5 μg/kg) and fentanyl was 30.0 ± 11.9 μg (0.43 ± 0.17 μg/kg). Median entrance dose of radiation at the patient plane was 25 (interquartile range: 16-57) mGy, and did not differ between ASD and PFO procedures (p = 0.614). The majority of patients were free of complications (91.0%). The following early complications were observed: transient ischaemic attack (n = 2, 1.6%), supraventricular arrhythmias (n = 4, 3.3%), left atrial thrombus formation (n = 1, 0.8%), symptomatic bradycardia (n = 1, 0.8%), and femoral venous bleeding (n = 5, 4.1%). After mean follow-up of 386 days residual shunt was observed in eight (6.6%) patients.
Conscious sedation for transcatheter implantation of ASO is a feasible, safe, and efficient technique, allowing successful PFO and ASD closure in the majority of patients.
全身麻醉可能会对患者的死亡率和发病率以及整体手术成本产生负面影响，尤其是在房间隔缺损封堵器（ASO）植入术中。
我们旨在评估清醒镇静在经导管 ASO 植入术中的安全性、疗效和可行性。
共纳入 122 例拟行经导管 ASO 植入术的患者。患者平均年龄为 51±15 岁，43 例（35%）为男性。咪达唑仑初始剂量为 2mg，芬太尼剂量为 25μg。如果需要，可追加咪达唑仑和芬太尼。每 10min 评估患者的反应性，并滴定镇静剂剂量，以避免 Ramsay 镇静评分达到 3 级。
大多数患者（98.4%）成功植入了房间隔缺损封堵器。在 2 例（1.6%）患者中，由于卵圆孔未闭（PFO）直径过小（n=1，0.8%）或器械不稳定（n=1，0.8%），手术失败。手术平均时间为 47.6±28.4min，ASD 和 PFO 关闭的手术时间相似（p=0.522）。咪达唑仑的平均总剂量为 4.7±2.2mg（63.9±32.5μg/kg），芬太尼为 30.0±11.9μg（0.43±0.17μg/kg）。患者层面的辐射入射剂量中位数为 25（四分位距：16-57）mGy，ASD 和 PFO 手术之间无差异（p=0.614）。大多数患者无并发症（91.0%）。观察到以下早期并发症：短暂性脑缺血发作（n=2，1.6%）、室上性心律失常（n=4，3.3%）、左心房血栓形成（n=1，0.8%）、症状性心动过缓（n=1，0.8%）和股静脉出血（n=5，4.1%）。平均随访 386 天后，8 例（6.6%）患者仍存在残余分流。
清醒镇静在经导管 ASO 植入术中是一种可行、安全且有效的技术，可使大多数患者成功进行 PFO 和 ASD 关闭。
