Catheterization laboratory, Cardiothoracic and Vascular Department.
Cardiothoracic and vascular Anaesthesiology and Intensive Care, Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
J Cardiovasc Med (Hagerstown). 2022 Dec 1;23(12):801-806. doi: 10.2459/JCM.0000000000001391. Epub 2022 Oct 7.
Local instead of general anesthesia has become the standard approach in many centers for transfemoral transcatheter aortic valve replacement (TAVR). New generation devices and an increase in operator skills had led to a drastic reduction in periprocedural complications, bringing in the adoption of a minimalist approach. In our study, we aimed to compare patients treated with TAVR under local anesthesia with or without the presence of an anesthesiologist on site (AOS).
We compare procedural aspects and results of patients treated with TAVR with an AOS against patients treated with TAVR with an anesthesiologist on call (AOC). From January 2019 to December 2020, all consecutive patients undergoing transfemoral TAVR with either the self-expandable Evolut (Medtronic, MN, USA) or balloon-expandable SAPIEN 3 (Edwards Lifesciences, CA, USA) were collected.
Of 332 patients collected, 96 (29%) were treated with TAVR with AOS, while 236 (71%) were treated with TAVR with AOC. No differences in procedural time, fluoroscopy time and amount of contrast medium were observed. No procedural death and conversion to open-chest surgery was reported. The rate of stroke/transient ischemic attacks and major vascular complications was similar in the two groups. No patients in both groups required conversion to general anesthesia. Two patients (0.8%) in the AOC group required urgent intervention of the anesthesiologist. In the AOC group, there was a greater use of morphine (55.9% vs. 33.3%, P = 0.008), but with a lower dose for each patient (2.0 vs. 2.8 mg, P = 0.006). On the other hand, there was a lower use of other painkiller drugs (3.4% vs. 20.8%, P = 0.001). No difference in inotropic drugs use was observed.
In patients at low or intermediate risk undergoing transfemoral TAVR, a safe procedure can be performed under local anesthesia without the presence of an anesthesiologist in the catheterization laboratory.
在许多中心，经股动脉经导管主动脉瓣置换术（TAVR）已采用局部麻醉而非全身麻醉作为标准治疗方法。新一代器械和操作人员技能的提高，使得围手术期并发症大幅减少，从而采用了极简主义的方法。在本研究中，我们旨在比较在局麻下接受 TAVR 治疗的患者，以及在导管室是否有麻醉师在场（AOS）的患者。
我们比较了 2019 年 1 月至 2020 年 12 月期间接受经股动脉 TAVR 治疗的患者中，有麻醉师在场（AOS）与有麻醉师随叫随到（AOC）的患者的手术过程和结果。所有患者均接受自膨式 Evolut（美敦力，明尼苏达州，美国）或球囊扩张式 SAPIEN 3（爱德华兹生命科学公司，加利福尼亚州，美国）。
在 332 例患者中，96 例（29%）接受 AOS 下的 TAVR 治疗，236 例（71%）接受 AOC 下的 TAVR 治疗。手术时间、透视时间和造影剂用量无差异。无手术死亡和中转开胸手术。两组间卒中/短暂性脑缺血发作和大血管并发症发生率相似。两组均无患者需转为全身麻醉。AOC 组中有 2 例（0.8%）患者需紧急麻醉师干预。AOC 组中，吗啡使用率较高（55.9% vs. 33.3%，P=0.008），但每位患者的剂量较低（2.0 毫克 vs. 2.8 毫克，P=0.006）。另一方面，其他止痛药的使用率较低（3.4% vs. 20.8%，P=0.001）。正性肌力药物的使用无差异。
在低危或中危患者中，经股动脉 TAVR 可在局部麻醉下安全进行，无需麻醉师在导管室。
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