Department of Cardiology, Mater Misericordiae University Hospital, Dublin 7, Ireland.
J Invasive Cardiol. 2021 Mar;33(3):E220-E224. Epub 2021 Feb 4.
To compare the safety of performing transfemoral transcatheter aortic valve replacement (TAVR) under conscious sedation without an anesthetist present (TAVR-NA) vs TAVR performed with an anesthetist supervising sedation (TAVR-A).
In almost all United States and European centers, TAVR-A represents the standard of care. There are limited data on the safety of TAVR-NA.
The prospective Mater TAVR database was analyzed. Patients undergoing transfemoral TAVR under conscious sedation were identified and divided into 2 groups, ie, TAVR-NA and TAVR-A. Demographics, procedural characteristics, and clinical outcomes for each group were assessed and compared.
From a cohort of 300 patients who underwent transfemoral TAVR under conscious sedation, TAVR-NA and TAVR-A were performed in 85 patients and 215 patients, respectively. Baseline variables were similar except for a higher median Society of Thoracic Surgeons score in the TAVR-NA group vs the TAVR-A group (5.1% vs 4.4% in the TAVR-A group; P=.05). TAVR-A patients had a higher rate of conversion to general anesthesia (4.2% vs 1.2% in the TAVR-NA group; P=.29), with 1 patient in each group requiring conversion to emergency surgery. In-lab and in-hospital complication rates were similar in the TAVR-NA and TAVR-A groups (7.1% vs 6.5% [P=.86] and 8.2% vs 12.1% [P=.34], respectively). The Kaplan-Meier estimate of freedom from mortality and/or stroke at 1 month was comparable between both groups (96.5% vs 97.7%; P=.57).
In this modest-sized transfemoral TAVR cohort with a low conversion rate to emergency surgery, TAVR-NA was associated with safety outcomes that were equivalent to TAVR-A. In healthcare systems where access to TAVR may be limited by anesthetic resources, TAVR-NA appears to be a reasonable option to enable the application of this therapy.
比较在无麻醉师在场的情况下进行经股动脉经导管主动脉瓣置换术（TAVR）的安全性（TAVR-NA）与有麻醉师监督镇静下进行 TAVR（TAVR-A）的安全性。
几乎在美国和欧洲的所有中心，TAVR-A 都代表了标准的治疗方法。关于 TAVR-NA 的安全性数据有限。
对前瞻性 Mater TAVR 数据库进行了分析。识别出并分为 2 组，即 TAVR-NA 和 TAVR-A，在意识镇静下接受经股 TAVR 的患者。评估并比较每组的人口统计学、手术特点和临床结局。
在 300 例接受经股 TAVR 意识镇静的患者中，85 例患者接受了 TAVR-NA，215 例患者接受了 TAVR-A。除 TAVR-NA 组的中位胸外科医生协会评分高于 TAVR-A 组（5.1%对 4.4%；P=.05）外，基线变量相似。TAVR-A 患者转为全身麻醉的发生率较高（4.2%对 TAVR-NA 组的 1.2%；P=.29），每组各有 1 例患者需要转为急诊手术。TAVR-NA 和 TAVR-A 组的实验室和住院并发症发生率相似（7.1%对 6.5%[P=.86]和 8.2%对 12.1%[P=.34]）。两组 1 个月时免于死亡和/或中风的 Kaplan-Meier 估计值相似（96.5%对 97.7%；P=.57）。
在这个经股 TAVR 队列中，手术转化率低，且没有紧急手术，TAVR-NA 与 TAVR-A 相比，安全性结果相当。在 TAVR 可因麻醉资源而受到限制的医疗保健系统中，TAVR-NA 似乎是一种合理的选择，可使这种治疗方法得以应用。
