Objective To determine the impact of perioperative thoracic epidural analgesia (TEA) on acute and late outcomes following transapical transcatheter aortic valve implantation (TA-TAVI).
Patients and intervention A total of 135 consecutive patients who underwent TA-TAVI were included. All patients received catheter-based pain control, either via TEA (TEA group, n=74) or intercostal local analgesia with a catheter placed at the surgical incision site (non-TEA group, n=61), depending on the preference of the anaesthesiologist responsible for the case.
Main outcome measures Pain level during early postoperative period (verbal rating scale from 1 to 10), 30-day/in-hospital complications and mortality, and 1-year mortality.
Results There were no differences in baseline or procedural characteristics between groups except for a lower left ventricular ejection fraction in the TEA group. The maximal pain score related to thoracotomy in the postoperative period was higher in the non-TEA group as compared with the TEA group (4 (IQR: 3–5)) vs 2 (IQR: 1–3), p<0.001). Non-TEA was associated with a higher rate of pulmonary complications (p<0.05 for nosocomial pneumonia, reintubation and tracheostomy). The 30-day/in-hospital mortality rate was higher in the non-TEA group (22.9% vs 2.7% in the TEA group, p<0.001). At 1-year follow-up, overall mortality remained higher in the non-TEA group (31.1%) compared with the TEA group (10.8%), p=0.005. Similar periprocedural and late results were obtained in a propensity score-matched analysis that included 100 matched patients. In the multivariable analysis, STS score (p=0.027) and absence of TEA (p=0.039) were independent predictors of increased cumulative late mortality.
Conclusions TEA provided superior analgesia following TA-TAVI, and was associated with a dramatic reduction in periprocedural respiratory complications, and both, short- and long-term mortality. These results highlight the importance of obtaining optimal analgesia following TA-TAVI to improve the results associated with this procedure.
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- Aortic valve disease
- transcatheter aortic valve implantation
- interventional cardiology
- non-coronary intervention
- percutaneous valve therapy
- myocardial ischaemia and infarction
- cardiac function
- coronary artery disease
- coronary physiology
- allied specialities
- coronary collateral circulation
- chronic total occlusion
- aortic stenosis
- valve disease
- prosthetic heart valves
- coronary stenting
- mitral stenosis
Funding Dr IJA-S received support from the Institute of Heart Sciences (ICICOR, Clinical Hospital of Valladolid, Spain).
Competing interests Dr ED is consultant for Edwards Lifesciences; Dr DJC has received research grant support from Edwards Lifesciences and Medtronic Inc. Dr JR-C is consultant for Edwards Lifesciences and St Jude Medical.
Ethics approval The study protocol was performed in accordance with the institutional ethics committee.
Provenance and peer review Not commissioned; externally peer reviewed.
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