Haurand Jean Marc, Kavsur Refik, Ochs Laurin, Tanaka Tetsu, Iliadis Christos, Sugiura Atsushi, Kelm Malte, Nickenig Georg, Baldus Stephan, Westenfeld Ralf, Becher Marc Ulrich, Pfister Roman, Horn Patrick
Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Düsseldorf, Düsseldorf, Germany.
Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, University Hospital Bonn, Bonn, Germany.
Front Cardiovasc Med. 2022 Aug 31;9:976822. doi: 10.3389/fcvm.2022.976822. eCollection 2022.
Transcatheter tricuspid valve repair (TTVr) is routinely performed under general anesthesia (GA). This study aimed to investigate whether TTVr procedures can be performed effectively and safely without GA but using deep sedation (DS).
We performed a retrospective analysis of 104 patients from three centers who underwent TTVr between 2020 and 2021. The primary performance endpoints were technical success and severity of TR assessed at the time of discharge. The safety outcome was a composite of in-hospital complications, including occurrence of death, conversion to surgery, major adverse cardiac and cerebrovascular events, major vascular complications, or occurrence of pneumonia.
Sixty-four procedures were performed in GA and 40 procedures were performed in DS. The groups did not differ in age, EuroScore II, TR severity, ventricular function, or hemodynamic parameters. Technical success was achieved in 92.5% of the patients in the DS group and in 93.6% of the patients in the GA group ( = 0.805). In none of the patients intraprocedural conversion from DS to GA was required. There was no difference in total duration of the procedure, and number of devices implanted. The degree of TR was ≤2+ in 77.5% of the patients in the DS group and in 74.2% of the patients in the GA group ( = 0.705). The composite safety endpoint did not differ between the groups (2.5 vs. 6.3%, = 0.384). The total duration of hospital stay was shorter in patients who underwent TTVr in DS compared to those who underwent TTVr in GA (6 [5, 9] days vs. 8 [6, 11] days; = 0.011).
Performing TTVr in DS was effective with similar procedural results, and was safe with similar low complication rates compared to GA.
经导管三尖瓣修复术（TTVr）通常在全身麻醉（GA）下进行。本研究旨在探讨TTVr手术在不使用GA但采用深度镇静（DS）的情况下能否有效且安全地进行。
我们对2020年至2021年间在三个中心接受TTVr的104例患者进行了回顾性分析。主要性能终点是出院时评估的技术成功率和三尖瓣反流（TR）的严重程度。安全结果是院内并发症的综合情况，包括死亡、转为手术、主要不良心脑血管事件、主要血管并发症或肺炎的发生。
64例手术在GA下进行，40例手术在DS下进行。两组在年龄、欧洲心脏手术风险评估系统（EuroScore）II、TR严重程度、心室功能或血流动力学参数方面无差异。DS组92.5%的患者和GA组93.6%的患者实现了技术成功（P = 0.805）。所有患者术中均无需从DS转为GA。手术总时长和植入器械数量无差异。DS组77.5%的患者和GA组74.2%的患者TR程度≤2+（P = 0.705）。两组的综合安全终点无差异（2.5%对6.3%，P = 0.384）。与GA下接受TTVr的患者相比，DS下接受TTVr的患者住院总时长更短（6[5, 9]天对8[6, 11]天；P = 0.011）。
与GA相比，在DS下进行TTVr是有效的，手术结果相似，且安全，并发症发生率同样较低。
