Domoto Satoru, Azuma Takashi, Nakazawa Keisuke, Yokoi Yoshihiko, Hayakawa Minako, Yamagata Akiko, Isomura Shogo, Nomura Minoru, Niinami Hiroshi
Department of Cardiovascular Surgery, Tokyo, 162-8666, Japan.
Department of Anesthesiology, The Heart Institute of Japan, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan.
Gen Thorac Cardiovasc Surg. 2021 Feb;69(2):267-273. doi: 10.1007/s11748-020-01452-w. Epub 2020 Jul 28.
Thoracic endovascular aortic repair (TEVAR) is typically performed with general anesthesia (GA) and surgical cutdown (G-TEVAR). As the latest generation of TEVAR delivery systems are smaller, we introduced percutaneous TEVAR with regional anesthesia (RA) (R-TEVAR) and an arteriotomy closure device. In this study, we compare the safety and efficacy of R-TEVAR to that of the G-TEVAR.
This single-center observational study included consecutive patients who underwent either G-TEVAR between January 2015 and October 2018 (33 patients) or R-TEVAR (41 patients) between January 2018 and April 2020. RA was achieved using an ultrasound-guided nerve block.
The mean outer diameter of the delivery device was significantly smaller in R-TEVAR (18.5 vs. 22.7 Fr; p < 0.01) and the time from arriving into the operating room to beginning of surgery (34.1 vs. 68.5 min; p < 0.01), procedural time (46.4 vs. 103.6 min; p < 0.01), and operating room stay time (108.3 vs. 194.6 min; p < 0.01) were significantly shorter. The mean rate of change in blood pressure was significantly lower in the R-TEVAR group (7.7% vs. 32.2%; p < 0.01). One case of spinal cord ischemia occurred in the G-TEVAR group (0% vs. 3.0%; p = 0.262) and one case of inadequate hemostasis and conversion to surgical cutdown without GA occurred in the R-TEVAR group (2.4% vs. 0%; p = 0.366).
The R-TEVAR is safe and minimally invasive. Further, RA may provide additional benefits of mean blood pressure stability and early recognition of neurologic complications.
胸主动脉腔内修复术（TEVAR）通常在全身麻醉（GA）和手术切开的情况下进行（G-TEVAR）。由于最新一代的TEVAR输送系统体积更小，我们引入了采用区域麻醉（RA）的经皮TEVAR（R-TEVAR）和动脉切开闭合装置。在本研究中，我们比较了R-TEVAR与G-TEVAR的安全性和有效性。
这项单中心观察性研究纳入了2015年1月至2018年10月期间接受G-TEVAR治疗的连续患者（33例）以及2018年1月至2020年4月期间接受R-TEVAR治疗的连续患者（41例）。通过超声引导神经阻滞实现区域麻醉。
R-TEVAR中输送装置的平均外径显著更小（18.5对比22.7F；p＜0.01），从进入手术室到开始手术的时间（34.1对比68.5分钟；p＜0.01）、手术时间（46.4对比103.6分钟；p＜0.01）以及手术室停留时间（108.3对比194.6分钟；p＜0.01）均显著更短。R-TEVAR组血压的平均变化率显著更低（7.7%对比32.2%；p＜0.01）。G-TEVAR组发生1例脊髓缺血（0%对比3.0%；p = 0.262），R-TEVAR组发生1例止血不充分且未行全身麻醉而转为手术切开的情况（2.4%对比0%；p = 0.366）。
R-TEVAR安全且微创。此外，区域麻醉可能在平均血压稳定性和早期识别神经并发症方面带来额外益处。
