Comparison of the outcomes of local anesthesia and general anesthesia in transcatheter aortic valve replacement_West China Medical Journal

Authors：

CHENG Yang , LI Xi , LI Yijian , OU Yuanweixiang , WANG Xi , LI Qiao , PENG Yong ,  FENG Yuan ,  CHEN Mao

Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

FENG Yuan, Email: fynotebook@hotmail.com; CHEN Mao, Email: hmaochen@vip.sina.com

Keywords：

Transcatheter aortic valve replacement; Local anesthesia; General anesthesia; Mortality; Severe aortic stenosis

DOI：

10.7507/1002-0179.202008149

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Objective To compare the outcomes of local anesthesia and general anesthesia in transcatheter aortic valve replacement (TAVR).Methods A total of 399 severe aortic stenosis patients were included, who underwent TAVR successfully in West China Hospital of Sichuan University between April 2012 and January 2019. The baseline characteristics, procedural details, postprocedural outcomes, and ultrasound data of those patients were collected. All patients were followed up and the end date of follow-up was June 20th 2020. According to anesthetic mode, the patients were divided into local anesthesia group and general anesthesia group. The differences between the two groups in incidence of postprocedural complications, hemodynamics, postprocedural 30-day mortality, and postprocedural 1-year mortality were retrospectively analyzed.Results Of the 399 patients, 206 (51.6%) received local anesthesia and 193 (48.4%) received general anesthesia. There was no statistical difference between the two groups in baseline characteristics. The symptoms of both groups were relieved. But the incidences of mild bleeding events (12.4% vs. 1.5%, P<0.001), severe bleeding events (10.4% vs. 0.5%, P<0.001), major vascular complications (0.5% vs. 3.6%, P=0.032), and postprocedural 30-day all causes mortality (1.9% vs. 6.7%, P=0.018) were significantly lower in the local anesthesia group than those in the general anesthesia group.Conclusion In TAVR, compared with general anesthesia, local anesthesia is safer to use with lower incidence of postprocedural complications and postprocedural 30-day all causes mortality.

Citation： CHENG Yang, LI Xi, LI Yijian, OU Yuanweixiang, WANG Xi, LI Qiao, PENG Yong, FENG Yuan, CHEN Mao. Comparison of the outcomes of local anesthesia and general anesthesia in transcatheter aortic valve replacement. West China Medical Journal, 2020, 35(9): 1055-1059. doi: 10.7507/1002-0179.202008149 Copy

1.	中国医师协会心血管内科医师分会结构性心脏病专业委员, 中华医学会心血管病学分会结构性心脏病学组. 经导管主动脉瓣置换术中国专家共识. 中国介入心脏病学杂志, 2015, 23(12): 661-667.
2.	Cribier A, Eltchaninoff H, Bash A, et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation, 2002, 106(24): 3006-3008.
3.	Makkar RR, Thourani VH, Mack MJ, et al. Five-year outcomes of transcatheter or surgical aortic-valve replacement. N Engl J Med, 2020, 382(9): 799-809.
4.	Sardar P, Kundu A, Chatterjee S, et al. Transcatheter versus surgical aortic valve replacement in intermediate-risk patients: evidence from a meta-analysis. Catheter Cardiovasc Interv, 2017, 90(3): 504-515.
5.	Oguri A, Yamamoto M, Mouillet G, et al. Clinical outcomes and safety of transfemoral aortic valve implantation under general versus local anesthesia: subanalysis of the French Aortic National CoreValve and Edwards 2 registry. Circ Cardiovasc Interv, 2014, 7(4): 602-610.
6.	Maas EH, Pieters BM, Van de Velde M, et al. General or local anesthesia for TAVI? A systematic review of the literature and meta-analysis. Curr Pharm Des, 2016, 22(13): 1868-1878.
7.	Brecker SJ, Bleiziffer S, Bosmans J, et al. Impact of anesthesia type on outcomes of transcatheter aortic valve implantation (from the Multicenter ADVANCE Study). Am J Cardiol, 2016, 117(8): 1332-1338.
8.	Miles LF, Joshi KR, Ogilvie EH, et al. General anaesthesia vs. conscious sedation for transfemoral aortic valve implantation: a single UK centre before-and-after study. Anaesthesia, 2016, 71(8): 892-900.
9.	Husser O, Fujita B, Hengstenberg C, et al. Conscious sedation versus general anesthesia in transcatheter aortic valve replacement: the German aortic valve registry. JACC Cardiovasc Interv, 2018, 11(6): 567-578.
10.	Mosleh W, Mather JF, Amer MR, et al. Propensity matched analysis comparing conscious sedation versus general anesthesia in transcatheter aortic valve implantation. Am J Cardiol, 2019, 124(1): 70-77.
11.	Dall’Ara G, Eltchaninoff H, Moat N, et al. Local and general anaesthesia do not influence outcome of transfemoral aortic valve implantation. Int J Cardiol, 2014, 177(2): 448-454.
12.	Butala NM, Chung M, Secemsky EA, et al. Conscious sedation versus general anesthesia for transcatheter aortic valve replacement: variation in practice and outcomes. JACC Cardiovasc Interv, 2020, 13(11): 1277-1287.
13.	Yamamoto M, Meguro K, Mouillet G, et al. Effect of local anesthetic management with conscious sedation in patients undergoing transcatheter aortic valve implantation. Am J Cardiol, 2013, 111(1): 94-99.
14.	Hyman MC, Vemulapalli S, Szeto WY, et al. Conscious sedation versus general anesthesia for transcatheter aortic valve replacement: insights from the National Cardiovascular Data Registry Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. Circulation, 2017, 136(22): 2132-2140.
15.	Villablanca PA, Mohananey D, Ramakrishna H. Comparison of local versus general anesthesia in patients undergoing transcatheter aortic valve replacement: an updated meta-analysis. Catheter Cardiovasc Interv, 2018, 92(5): 1018-1019.
16.	Dehédin B, Guinot PG, Ibrahim H, et al. Anesthesia and perioperative management of patients who undergo transfemoral transcatheter aortic valve implantation: an observational study of general versus local/regional anesthesia in 125 consecutive patients. J Cardiothorac Vasc Anesth, 2011, 25(6): 1036-1043.
17.	Attizzani GF, Alkhalil A, Padaliya B, et al. Comparison of outcomes of transfemoral transcatheter aortic valve implantation using a minimally invasive versus conventional strategy. Am J Cardiol, 2015, 116(11): 1731-1736.
18.	Eltchaninoff H, Prat A, Gilard M, et al. Transcatheter aortic valve implantation: early results of the France (French Aortic National CoreValve and Edwards) registry. Eur Heart J, 2011, 32(2): 191-197.
19.	Kappetein AP, Head SJ, Généreux P, et al. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. J Thorac Cardiovasc Surg, 2013, 145(1): 6-23.

1. 中国医师协会心血管内科医师分会结构性心脏病专业委员, 中华医学会心血管病学分会结构性心脏病学组. 经导管主动脉瓣置换术中国专家共识. 中国介入心脏病学杂志, 2015, 23(12): 661-667.
2. Cribier A, Eltchaninoff H, Bash A, et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation, 2002, 106(24): 3006-3008.
3. Makkar RR, Thourani VH, Mack MJ, et al. Five-year outcomes of transcatheter or surgical aortic-valve replacement. N Engl J Med, 2020, 382(9): 799-809.
4. Sardar P, Kundu A, Chatterjee S, et al. Transcatheter versus surgical aortic valve replacement in intermediate-risk patients: evidence from a meta-analysis. Catheter Cardiovasc Interv, 2017, 90(3): 504-515.
5. Oguri A, Yamamoto M, Mouillet G, et al. Clinical outcomes and safety of transfemoral aortic valve implantation under general versus local anesthesia: subanalysis of the French Aortic National CoreValve and Edwards 2 registry. Circ Cardiovasc Interv, 2014, 7(4): 602-610.
6. Maas EH, Pieters BM, Van de Velde M, et al. General or local anesthesia for TAVI? A systematic review of the literature and meta-analysis. Curr Pharm Des, 2016, 22(13): 1868-1878.
7. Brecker SJ, Bleiziffer S, Bosmans J, et al. Impact of anesthesia type on outcomes of transcatheter aortic valve implantation (from the Multicenter ADVANCE Study). Am J Cardiol, 2016, 117(8): 1332-1338.
8. Miles LF, Joshi KR, Ogilvie EH, et al. General anaesthesia vs. conscious sedation for transfemoral aortic valve implantation: a single UK centre before-and-after study. Anaesthesia, 2016, 71(8): 892-900.
9. Husser O, Fujita B, Hengstenberg C, et al. Conscious sedation versus general anesthesia in transcatheter aortic valve replacement: the German aortic valve registry. JACC Cardiovasc Interv, 2018, 11(6): 567-578.
10. Mosleh W, Mather JF, Amer MR, et al. Propensity matched analysis comparing conscious sedation versus general anesthesia in transcatheter aortic valve implantation. Am J Cardiol, 2019, 124(1): 70-77.
11. Dall’Ara G, Eltchaninoff H, Moat N, et al. Local and general anaesthesia do not influence outcome of transfemoral aortic valve implantation. Int J Cardiol, 2014, 177(2): 448-454.
12. Butala NM, Chung M, Secemsky EA, et al. Conscious sedation versus general anesthesia for transcatheter aortic valve replacement: variation in practice and outcomes. JACC Cardiovasc Interv, 2020, 13(11): 1277-1287.
13. Yamamoto M, Meguro K, Mouillet G, et al. Effect of local anesthetic management with conscious sedation in patients undergoing transcatheter aortic valve implantation. Am J Cardiol, 2013, 111(1): 94-99.
14. Hyman MC, Vemulapalli S, Szeto WY, et al. Conscious sedation versus general anesthesia for transcatheter aortic valve replacement: insights from the National Cardiovascular Data Registry Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. Circulation, 2017, 136(22): 2132-2140.
15. Villablanca PA, Mohananey D, Ramakrishna H. Comparison of local versus general anesthesia in patients undergoing transcatheter aortic valve replacement: an updated meta-analysis. Catheter Cardiovasc Interv, 2018, 92(5): 1018-1019.
16. Dehédin B, Guinot PG, Ibrahim H, et al. Anesthesia and perioperative management of patients who undergo transfemoral transcatheter aortic valve implantation: an observational study of general versus local/regional anesthesia in 125 consecutive patients. J Cardiothorac Vasc Anesth, 2011, 25(6): 1036-1043.
17. Attizzani GF, Alkhalil A, Padaliya B, et al. Comparison of outcomes of transfemoral transcatheter aortic valve implantation using a minimally invasive versus conventional strategy. Am J Cardiol, 2015, 116(11): 1731-1736.
18. Eltchaninoff H, Prat A, Gilard M, et al. Transcatheter aortic valve implantation: early results of the France (French Aortic National CoreValve and Edwards) registry. Eur Heart J, 2011, 32(2): 191-197.
19. Kappetein AP, Head SJ, Généreux P, et al. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. J Thorac Cardiovasc Surg, 2013, 145(1): 6-23.

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