Department of Extracorporeal Circulation, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China.
Department of Structural Heart Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China.
Heart Surg Forum. 2021 Feb 8;24(1):E082-E100. doi: 10.1532/hsf.3361.
To examine key impacts of anesthesia on new-onset atrial fibrillation (AF) and acute kidney injury (AKI) in transcatheter aortic valve replacement (TAVR).
All consecutive patients who underwent transfemoral, transapical, and transaortic TAVR in Fuwai Hospital from 2012 to 2018 were retrospectively analyzed and dichotomized into 2 groups: TAVR under conscious sedation (CS) and under general anesthesia (GA). The primary endpoint was a composite of all-cause mortality, stroke, AF, permanent pacemaker implantation, myocardial infarction, heart failure, high-grade atrioventricular block, and AKI at 1 year. Binary logistic regression and adjusted multilevel logistic regression were performed to analyze the predictors of AF and AKI.
A total of 107 patients were under CS and 66 patients under GA. No significant difference was observed in the composite endpoint (51.5% vs. 41.2%, GA vs. CS, P = .182) and ≥ mild paravalvular leakage (36.4% vs. 31.4%, GA vs. CS, P = .589) at 1 year. However, the GA group had a significantly higher rate of intensive care unit (ICU) admission (84.8% vs. 6.5%, P < .001), AKI (28.8% vs. 14.0%, P = .018), new-onset AF (15.2% vs. 5.5% at 1 year, P = .036). Multivariable analysis revealed GA to be the significant predictor of new-onset AF (odds ratio 3.237, 95% confidence interval 1.059 to 9.894, P = .039) and AKI (odds ratio 2.517, 95% confidence interval 1.013 to 6.250, P = .047).
GA was associated with higher rates of ICU admission, postoperative AKI, and new-onset AF. The results may provide new evidence that CS challenges universal GA.
探讨麻醉对经导管主动脉瓣置换术（TAVR）中新发心房颤动（AF）和急性肾损伤（AKI）的关键影响。
回顾性分析 2012 年至 2018 年期间在中国医学科学院阜外医院接受经股动脉、经心尖和经主动脉 TAVR 的所有连续患者，并将其分为 2 组：接受镇静麻醉（CS）和全身麻醉（GA）的 TAVR。主要终点是 1 年内全因死亡率、卒、AF、永久性起搏器植入、心肌梗死、心力衰竭、高级房室传导阻滞和 AKI 的复合终点。采用二项逻辑回归和调整多水平逻辑回归分析 AF 和 AKI 的预测因素。
共 107 例患者接受 CS，66 例患者接受 GA。1 年内复合终点（GA 组为 51.5%，CS 组为 41.2%，GA 组 vs. CS 组，P =.182）和≥轻度瓣周漏（GA 组为 36.4%，CS 组为 31.4%，GA 组 vs. CS 组，P =.589）无显著差异。然而，GA 组 ICU 入住率（84.8% vs. 6.5%，P <.001）、AKI（28.8% vs. 14.0%，P =.018）和新发 AF（1 年时 15.2% vs. 5.5%，P =.036）明显更高。多变量分析显示 GA 是新发 AF（比值比 3.237，95%置信区间 1.059 至 9.894，P =.039）和 AKI（比值比 2.517，95%置信区间 1.013 至 6.250，P =.047）的显著预测因素。
GA 与 ICU 入住率较高、术后 AKI 和新发 AF 相关。结果可能提供新的证据，表明 CS 挑战了普遍的 GA。
