Anaesthetic management of transcatheter aortic valve implantation

results from the Italian CoreValve registry

A. Sonia Petronio, Cristina Giannini, Marco Di Carlo, Francesco Bedogni, Antonio Colombo, Corrado Tamburino, Silvio Klugmann, Arnaldo Poli, Fabio Guarracino, Marco Barbanti, Azeem Latib, Nedy Brambilla, Claudia Fiorina, Giuseppe Bruschi, Paola Martina, Federica Ettori

Research output: Contribution to journalArticle

Abstract

AIMS: Transcatheter aortic valve implantation (TAVI) represents a valid therapeutic alternative for patients with severe aortic stenosis at high surgical risk. However, there is no general consensus regarding the role of anaesthesia in TAVI management. The goal of this clinical project was to assess the safety and non-inferiority of local anaesthesia (LA) versus general anaesthesia (GA) in a large cohort of patients undergoing TAVI.

METHODS AND RESULTS: All 1,316 consecutive patients who underwent TAVI at seven high-volume Italian centres were enrolled. The anaesthetic regimen consisted of GA in 355 (26.9%) patients or LA in 961 (73.0%) patients. Baseline demographics were similar between the two groups except for a higher median logistic EuroSCORE (p=0.004) and peripheral artery disease (p<0.001) in the GA group. The two groups showed similar device success with no significant difference in terms of mortality, stroke and myocardial infarction. The overall procedural time was longer with the use of GA (p<0.001). The LA group showed a lower incidence of major access-site complications (p=0.01) and major (p=0.03) and life-threatening bleedings (p<0.001) with a lower occurrence of acute kidney injury stage 3 (p=0.002). Consistently, we observed a significantly shorter length of hospital stay in LA patients (8 days [7-13] vs. 7 days [6-10], GA vs. LA; p<0.001). As the GA patients were found to be at higher risk due to a higher prevalence of peripheral artery disease we carried out a propensity matching to obtain two comparable groups. This sub-analysis confirmed the same results previously observed in the overall population. As expected, in the GA group we observed longer procedural time, higher use of a surgical vascular access, higher incidence of acute kidney injury stage 3 and higher rate of bleeding and major vascular access-site complications.

CONCLUSIONS: Our study indicates that, in experienced centres which have gone beyond their initial learning curve with TAVI, the use of local anaesthesia in a selected patient population can be associated with good clinical outcomes. Nevertheless, as severe procedural complications are possible, an anaesthesiologist should always be present as part of the team.

Original languageEnglish
Pages (from-to)381-8
Number of pages8
JournalEuroIntervention
Volume12
Issue number3
DOIs
Publication statusPublished - Jun 20 2016

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Registries
Anesthetics
General Anesthesia
Local Anesthesia
Peripheral Arterial Disease
Acute Kidney Injury
Blood Vessels
Length of Stay
Hemorrhage
Learning Curve
Transcatheter Aortic Valve Replacement
Aortic Valve Stenosis
Incidence
Population
Anesthesia
Stroke
Myocardial Infarction
Demography
Safety
Equipment and Supplies

Keywords

  • Journal Article

Cite this

Anaesthetic management of transcatheter aortic valve implantation : results from the Italian CoreValve registry. / Petronio, A. Sonia; Giannini, Cristina; Di Carlo, Marco; Bedogni, Francesco; Colombo, Antonio; Tamburino, Corrado; Klugmann, Silvio; Poli, Arnaldo; Guarracino, Fabio; Barbanti, Marco; Latib, Azeem; Brambilla, Nedy; Fiorina, Claudia; Bruschi, Giuseppe; Martina, Paola; Ettori, Federica.

In: EuroIntervention, Vol. 12, No. 3, 20.06.2016, p. 381-8.

Research output: Contribution to journalArticle

Petronio, AS, Giannini, C, Di Carlo, M, Bedogni, F, Colombo, A, Tamburino, C, Klugmann, S, Poli, A, Guarracino, F, Barbanti, M, Latib, A, Brambilla, N, Fiorina, C, Bruschi, G, Martina, P & Ettori, F 2016, 'Anaesthetic management of transcatheter aortic valve implantation: results from the Italian CoreValve registry', EuroIntervention, vol. 12, no. 3, pp. 381-8. https://doi.org/10.4244/EIJY15M03_05
Petronio, A. Sonia ; Giannini, Cristina ; Di Carlo, Marco ; Bedogni, Francesco ; Colombo, Antonio ; Tamburino, Corrado ; Klugmann, Silvio ; Poli, Arnaldo ; Guarracino, Fabio ; Barbanti, Marco ; Latib, Azeem ; Brambilla, Nedy ; Fiorina, Claudia ; Bruschi, Giuseppe ; Martina, Paola ; Ettori, Federica. / Anaesthetic management of transcatheter aortic valve implantation : results from the Italian CoreValve registry. In: EuroIntervention. 2016 ; Vol. 12, No. 3. pp. 381-8.
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T2 - results from the Italian CoreValve registry

AU - Petronio, A. Sonia

AU - Giannini, Cristina

AU - Di Carlo, Marco

AU - Bedogni, Francesco

AU - Colombo, Antonio

AU - Tamburino, Corrado

AU - Klugmann, Silvio

AU - Poli, Arnaldo

AU - Guarracino, Fabio

AU - Barbanti, Marco

AU - Latib, Azeem

AU - Brambilla, Nedy

AU - Fiorina, Claudia

AU - Bruschi, Giuseppe

AU - Martina, Paola

AU - Ettori, Federica

PY - 2016/6/20

Y1 - 2016/6/20

N2 - AIMS: Transcatheter aortic valve implantation (TAVI) represents a valid therapeutic alternative for patients with severe aortic stenosis at high surgical risk. However, there is no general consensus regarding the role of anaesthesia in TAVI management. The goal of this clinical project was to assess the safety and non-inferiority of local anaesthesia (LA) versus general anaesthesia (GA) in a large cohort of patients undergoing TAVI.METHODS AND RESULTS: All 1,316 consecutive patients who underwent TAVI at seven high-volume Italian centres were enrolled. The anaesthetic regimen consisted of GA in 355 (26.9%) patients or LA in 961 (73.0%) patients. Baseline demographics were similar between the two groups except for a higher median logistic EuroSCORE (p=0.004) and peripheral artery disease (p<0.001) in the GA group. The two groups showed similar device success with no significant difference in terms of mortality, stroke and myocardial infarction. The overall procedural time was longer with the use of GA (p<0.001). The LA group showed a lower incidence of major access-site complications (p=0.01) and major (p=0.03) and life-threatening bleedings (p<0.001) with a lower occurrence of acute kidney injury stage 3 (p=0.002). Consistently, we observed a significantly shorter length of hospital stay in LA patients (8 days [7-13] vs. 7 days [6-10], GA vs. LA; p<0.001). As the GA patients were found to be at higher risk due to a higher prevalence of peripheral artery disease we carried out a propensity matching to obtain two comparable groups. This sub-analysis confirmed the same results previously observed in the overall population. As expected, in the GA group we observed longer procedural time, higher use of a surgical vascular access, higher incidence of acute kidney injury stage 3 and higher rate of bleeding and major vascular access-site complications.CONCLUSIONS: Our study indicates that, in experienced centres which have gone beyond their initial learning curve with TAVI, the use of local anaesthesia in a selected patient population can be associated with good clinical outcomes. Nevertheless, as severe procedural complications are possible, an anaesthesiologist should always be present as part of the team.

AB - AIMS: Transcatheter aortic valve implantation (TAVI) represents a valid therapeutic alternative for patients with severe aortic stenosis at high surgical risk. However, there is no general consensus regarding the role of anaesthesia in TAVI management. The goal of this clinical project was to assess the safety and non-inferiority of local anaesthesia (LA) versus general anaesthesia (GA) in a large cohort of patients undergoing TAVI.METHODS AND RESULTS: All 1,316 consecutive patients who underwent TAVI at seven high-volume Italian centres were enrolled. The anaesthetic regimen consisted of GA in 355 (26.9%) patients or LA in 961 (73.0%) patients. Baseline demographics were similar between the two groups except for a higher median logistic EuroSCORE (p=0.004) and peripheral artery disease (p<0.001) in the GA group. The two groups showed similar device success with no significant difference in terms of mortality, stroke and myocardial infarction. The overall procedural time was longer with the use of GA (p<0.001). The LA group showed a lower incidence of major access-site complications (p=0.01) and major (p=0.03) and life-threatening bleedings (p<0.001) with a lower occurrence of acute kidney injury stage 3 (p=0.002). Consistently, we observed a significantly shorter length of hospital stay in LA patients (8 days [7-13] vs. 7 days [6-10], GA vs. LA; p<0.001). As the GA patients were found to be at higher risk due to a higher prevalence of peripheral artery disease we carried out a propensity matching to obtain two comparable groups. This sub-analysis confirmed the same results previously observed in the overall population. As expected, in the GA group we observed longer procedural time, higher use of a surgical vascular access, higher incidence of acute kidney injury stage 3 and higher rate of bleeding and major vascular access-site complications.CONCLUSIONS: Our study indicates that, in experienced centres which have gone beyond their initial learning curve with TAVI, the use of local anaesthesia in a selected patient population can be associated with good clinical outcomes. Nevertheless, as severe procedural complications are possible, an anaesthesiologist should always be present as part of the team.

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DO - 10.4244/EIJY15M03_05

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JO - EuroIntervention

JF - EuroIntervention

SN - 1774-024X

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