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Valvular heart disease
Original research article
Comparison of general anaesthesia and non-general anaesthesia approach in transfemoral transcatheter aortic valve implantation
  1. Mehdi Eskandari1,
  2. Omar Aldalati1,
  3. Rafal Dworakowski1,
  4. Jonathan A Byrne1,
  5. Emma Alcock2,
  6. Olaf Wendler3,
  7. Philip A MacCarthy1,
  8. Peter F Ludman4,
  9. David J R Hildick-Smith5,
  10. Mark J Monaghan1
  11. on behalf of the UK TAVI Steering Committee and the National Institute for Cardiovascular Outcome Research
  1. 1 Department of Cardiology, King’s College Hospital, London, UK
  2. 2 Department of Anaesthesia, King’s College Hospital, London, UK
  3. 3 Department of Cardiothoracic Surgery, King’s College Hospital, London, UK
  4. 4 Department of Cardiology, University Hospitals Birmingham, Birmingham, UK
  5. 5 Department of Cardiology, Brighton and Sussex University Hospital, Brighton, UK
  1. Correspondence to Dr Mehdi Eskandari, Department of Cardiology, King’s College Hospital, London SE5 9RS, UK; mehdi.eskandari{at}nhs.net

Abstract

Objective Performing transfemoral transcatheter aortic valve implantation (TAVI) without general anaesthesia (GA) has been increasingly adopted. We sought to study the impact of GA and non-GA approaches on procedural outcome and 30-day and 1-year mortality in transfemoral TAVI.

Methods The UK TAVI registry holds information for every TAVI procedure in the UK. We analysed the data for patients implanted during 2013–2014 using either an Edwards Sapien or a Medtronic CoreValve prosthesis. Propensity score-matching analysis was performed to adjust for confounding factors.

Results 2243 patients were studied (aged 81.4±7.5 years, 1195 males). 1816 (81%) underwent TAVI with GA and 427 (19%) without GA. Transoesophageal echocardiography (TOE) was used in 92.3% of GA and 12.4% of non-GA cases (p<0.001). There was no significant difference in the rate of successful valve deployment (GA 97.2% vs non-GA 95.7%, p=0.104) and in the incidence of more than mild aortic regurgitation (AR) at the end of the procedure (GA 5.6% vs non-GA 7.0%, p=0.295). However, procedure time was longer (131±60 vs 121±60mins, p=0.002) and length of stay was greater (8.0±13.5 vs 5.7±5.5 days, p<0.001) for GA cases. 30-day and 1-year mortality rates did not differ between the GA and non-GA cases. After propensity matching, these results remained unchanged. A second propensity analysis (adjusted for mode of anaesthesia) did not show an association between use of TOE and rate of successful valve deployment or frequency of significant AR. Neither was TOE associated with a longer procedural time or greater length of stay.

Conclusion Procedure outcome, and 30-day and 1-year mortality are not influenced by mode of anaesthesia. However, GA is associated with longer procedure duration and greater length of stay.

  • echocardiography
  • aortic stenosis
  • transcatheter valve interventions

https://doi.org/10.1136/heartjnl-2017-312559

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    Footnotes

    • Contributors ME has participated in conception and design of the study, analysis and interpretation of the data, drafted the manuscript and approved the manuscript submitted. OA has participated in analysis and interpretation of the data, revising the draft critically for important intellectual content and has approved the manuscript submitted. RD, JB, PM, EA, PL, OW, DHS have participated in conception and design of the study, revising it critically for important intellectual content and approved the manuscript submitted. MM has participated in the conception and design of the study, analysis and interpretation of the data, revising the draft critically for important intellectual content; and has approved the manuscript submitted.

    • Funding The research posts of M. Eskandari and O. Aldalati have been funded by the King’s College Hospital Charity, London, United Kingdom.

    • Competing interests None declared.

    • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

    • Ethics approval The study was approved internally at King’s College Hospital,London, UK as well as by the Steering Committee of the National Institute for Cardiovascular Outcomes Research who granted the access to the UK TAVI database (un-identifiable data).

    • Provenance and peer review Not commissioned; externally peer reviewed.