Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
PLoS One. 2023 Aug 2;18(8):e0281232. doi: 10.1371/journal.pone.0281232. eCollection 2023.
Oxygen therapy is used in various clinical situation, but its clinical outcomes are inconsistent. The relationship between the fraction of inspired oxygen (FIO2) during transcatheter aortic valve implantation (TAVI) and clinical outcomes has not been well studied. We investigated the association of FIO2 (low vs. high) and myocardial injury in patients undergoing TAVI.
Adults undergoing transfemoral TAVI under general anesthesia were randomly assigned to receive FIO2 0.3 or 0.8 during procedure. The primary outcome was the area under the curve (AUC) for high-sensitivity cardiac troponin I (hs-cTnI) during the first 72 h following TAVI. Secondary outcomes included the AUC for postprocedural creatine kinase-myocardial band (CK-MB), acute kidney injury and recovery, conduction abnormalities, pacemaker implantation, stroke, myocardial infarction, and in-hospital mortality.
Between October 2017 and April 2022, 72 patients were randomized and 62 were included in the final analysis (n = 31 per group). The median (IQR) AUC for hs-cTnI in the first 72 h was 42.66 (24.82-65.44) and 71.96 (35.38-116.34) h·ng/mL in the FIO2 0.3 and 0.8 groups, respectively (p = 0.066). The AUC for CK-MB in the first 72 h was 257.6 (155.6-322.0) and 342.2 (195.4-485.2) h·ng/mL in the FIO2 0.3 and 0.8 groups, respectively (p = 0.132). Acute kidney recovery, defined as an increase in the estimated glomerular filtration rate ≥ 25% of baseline in 48 h, was more common in the FIO2 0.3 group (65% vs. 39%, p = 0.042). Other clinical outcomes were comparable between the groups.
The FIO2 level did not have a significant effect on periprocedural myocardial injury following TAVI. However, considering the marginal results, a benefit of low FIO2 during TAVI could not be ruled out.
氧气治疗在各种临床情况下都有使用，但临床结果并不一致。经导管主动脉瓣植入术（TAVI）期间吸入氧分数（FIO2）与临床结果之间的关系尚未得到很好的研究。我们研究了 FIO2（低 vs. 高）与 TAVI 患者心肌损伤之间的关系。
在全身麻醉下接受经股 TAVI 的成年人被随机分配在手术期间接受 FIO2 0.3 或 0.8。主要结局是 TAVI 后 72 小时内高敏心肌肌钙蛋白 I（hs-cTnI）的曲线下面积（AUC）。次要结局包括术后肌酸激酶同工酶-心肌带（CK-MB）、急性肾损伤和恢复、传导异常、起搏器植入、卒中和心肌梗死以及住院死亡率的 AUC。
2017 年 10 月至 2022 年 4 月，72 例患者被随机分配，62 例被纳入最终分析（每组 n = 31）。FIO2 0.3 和 0.8 组第 1 个 72 小时内 hs-cTnI 的中位数（IQR）AUC 分别为 42.66（24.82-65.44）和 71.96（35.38-116.34）h·ng/mL（p = 0.066）。FIO2 0.3 和 0.8 组第 1 个 72 小时内 CK-MB 的 AUC 分别为 257.6（155.6-322.0）和 342.2（195.4-485.2）h·ng/mL（p = 0.132）。FIO2 0.3 组急性肾恢复（定义为 48 小时内估计肾小球滤过率较基线增加≥25%）更为常见（65% vs. 39%，p = 0.042）。两组其他临床结局相当。
TAVI 后，FIO2 水平对围手术期心肌损伤没有显著影响。然而，考虑到边缘结果，不能排除 TAVI 期间低 FIO2 的益处。
