RT Journal Article
SR Electronic
T1 Effect of thoracic epidural analgesia on clinical outcomes following transapical transcatheter aortic valve implantation
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1583
OP 1590
DO 10.1136/heartjnl-2012-302185
VO 98
IS 21
A1 Ignacio J Amat-Santos
A1 Eric Dumont
A1 Jacques Villeneuve
A1 Daniel Doyle
A1 Michel Rheault
A1 Dominique Lavigne
A1 Jerôme Lemieux
A1 André St-Pierre
A1 Michael Mok
A1 Marina Urena
A1 Luis Nombela-Franco
A1 Steve Blackburn
A1 Mathieu Simon
A1 Christine Bourgault
A1 José Luis Carrasco
A1 Philippe Pibarot
A1 Melanie Côté
A1 Robert DeLarochellière
A1 David J Cohen
A1 Josep Rodés-Cabau
YR 2012
UL http://heart.bmj.com/content/98/21/1583.abstract
AB 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.