Bianco Valentino, Gleason Thomas G, Kilic Arman, Lee Joon S, Schindler John T, Rauso Louis, Arnold Joseph, Joshi Rama, Navid Forozan, Kliner Dustin, Sultan Ibrahim
Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA.
Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA.
J Cardiothorac Vasc Anesth. 2019 Jan;33(1):39-44. doi: 10.1053/j.jvca.2018.05.036. Epub 2018 May 26.
The use of monitored anesthesia care (MAC) for transcatheter aortic valve replacement (TAVR) is gaining favor in the United States, although general anesthesia (GA) continues to be common for these procedures. Open surgical cutdown for transfemoral TAVR has been a relative contraindication for TAVR with MAC at most centers. The objective of this study was to review the authors' results of transfemoral TAVR performed in patients with open surgical cutdown with the use of MAC.
Retrospective study design from a prospectively recorded database.
Tertiary academic (teaching) hospital.
Two hundred eighty-two patients undergoing transfemoral TAVR with open surgical cutdown under MAC from 2015 to 2017.
Transfemoral TAVR under MAC with surgical cutdown for femoral vascular access.
The study cohort consisted of 282 patients with severe aortic stenosis (mean area 0.65 [± 0.16] cm, mean gradient of 48.9 [±13.3] mmHg, and mean age of 82.7 [± 7.31] years). Eleven (3.9%) patients required conversion to GA. First postoperative pain score (0-10) was 2.9 and highest postoperative pain score was 4.6. Major and minor vascular complications occurred in 2 (0.7%) and 6 (2.1%) patients, respectively. Twenty-nine (10.3%) patients were readmitted within 30 days, and 6 (2.1%) patients had in-hospital mortality.
Open surgical cutdown for transfemoral TAVR can be performed safely using MAC and ilioinguinal block with low rates of conversion to general anesthesia and acceptable postoperative outcomes and pain scores.
在美国，经导管主动脉瓣置换术（TAVR）采用监护麻醉（MAC）正越来越受到青睐，尽管全身麻醉（GA）在这些手术中仍然很常见。在大多数中心，经股动脉TAVR手术时开放性外科切开一直是MAC用于TAVR的相对禁忌证。本研究的目的是回顾作者在采用MAC的情况下，对接受开放性外科切开的患者进行经股动脉TAVR的结果。
来自前瞻性记录数据库的回顾性研究设计。
三级学术（教学）医院。
2015年至2017年期间，282例接受MAC下经股动脉TAVR且有开放性外科切开的患者。
MAC下经股动脉TAVR并进行外科切开以建立股血管通路。
研究队列包括282例严重主动脉瓣狭窄患者（平均瓣口面积0.65[±0.16]cm，平均压差48.9[±13.3]mmHg，平均年龄82.7[±7.31]岁）。11例（3.9%）患者需要转为GA。术后首次疼痛评分（0 - 10分）为2分，术后最高疼痛评分为4.6分。分别有2例（0.7%）和6例（2.1%）患者发生了严重和轻微血管并发症。29例（10.3%）患者在30天内再次入院，6例（2.1%）患者院内死亡。
经股动脉TAVR的开放性外科切开在使用MAC和髂腹股沟阻滞的情况下可以安全进行，转为全身麻醉的比例较低，术后结果和疼痛评分均可接受。
