Transcatheter aortic valve implantation: General anesthesia using transesophageal echocardiography does not decrease the incidence of paravalvular leaks compared to sedation alone
Background: Transcatheter aortic valve implantation (TAVI) is a valid option for patients with severe aortic stenosis judged to be at high surgical risk. For this procedure, there is no agreement on the appropriate type of anesthesia. Sedation offers several advantages, but general anesthesia (GA) l...
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doaj-83402ce8a277429291eedfec75a82ea92020-11-24T21:36:59ZengWolters Kluwer Medknow PublicationsAnnals of Cardiac Anaesthesia0971-97842018-01-0121327728410.4103/aca.ACA_204_17Transcatheter aortic valve implantation: General anesthesia using transesophageal echocardiography does not decrease the incidence of paravalvular leaks compared to sedation aloneCédrick ZaouterSara SmailiLionel LerouxGuillaume BonnetSébastien LeuilletAlexandre OuattaraBackground: Transcatheter aortic valve implantation (TAVI) is a valid option for patients with severe aortic stenosis judged to be at high surgical risk. For this procedure, there is no agreement on the appropriate type of anesthesia. Sedation offers several advantages, but general anesthesia (GA) leads to less paravalvular leaks (PVLs) probably because of the transesophageal echocardiography (TEE) guidance. The objective was to compare the incidence of PVL among patients receiving conscious sedation (TAVI-S) and patients receiving GA (TAVI-GA). We made the hypothesis that a referral center does not necessitate TAVI-GA to reduce the incidence of moderate-to-severe PVL. Aim: The primary outcome was the incidence of moderate-to-severe PVL at 30 days after the implantation. Design and Setting: This study design was a retrospective observational trial in a university hospital. Methods: The TAVI-S group underwent the procedure under conscious sedation. In the TAVI-GA group, an endotracheal tube and a TEE probe were inserted. After the valve deployment, PVL was assessed by hemodynamic and fluoroscopic measurements in the TAVI-S group. TEE was also used in the TAVI-GA group to evaluate the presence of PVL. When PVL was moderate or severe according to the Valve Academic Research Consortium criteria. Results: TAVI-S and TAVI-GA were accomplished in 168 (67.5%) and 81 (32.5%) patients, respectively. Our results show no difference between the two groups regarding the incidence and grade of PVL. Conclusion: Performing TAVI under GA with TEE guidance is not associated with a lower incidence of moderate and severe PVL.http://www.annals.in/article.asp?issn=0971-9784;year=2018;volume=21;issue=3;spage=277;epage=284;aulast=ZaouterConscious sedationgeneral anesthesiaparavalvular leakstranscatheter aortic valve replacementtransesophageal echocardiography |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Cédrick Zaouter Sara Smaili Lionel Leroux Guillaume Bonnet Sébastien Leuillet Alexandre Ouattara |
spellingShingle |
Cédrick Zaouter Sara Smaili Lionel Leroux Guillaume Bonnet Sébastien Leuillet Alexandre Ouattara Transcatheter aortic valve implantation: General anesthesia using transesophageal echocardiography does not decrease the incidence of paravalvular leaks compared to sedation alone Annals of Cardiac Anaesthesia Conscious sedation general anesthesia paravalvular leaks transcatheter aortic valve replacement transesophageal echocardiography |
author_facet |
Cédrick Zaouter Sara Smaili Lionel Leroux Guillaume Bonnet Sébastien Leuillet Alexandre Ouattara |
author_sort |
Cédrick Zaouter |
title |
Transcatheter aortic valve implantation: General anesthesia using transesophageal echocardiography does not decrease the incidence of paravalvular leaks compared to sedation alone |
title_short |
Transcatheter aortic valve implantation: General anesthesia using transesophageal echocardiography does not decrease the incidence of paravalvular leaks compared to sedation alone |
title_full |
Transcatheter aortic valve implantation: General anesthesia using transesophageal echocardiography does not decrease the incidence of paravalvular leaks compared to sedation alone |
title_fullStr |
Transcatheter aortic valve implantation: General anesthesia using transesophageal echocardiography does not decrease the incidence of paravalvular leaks compared to sedation alone |
title_full_unstemmed |
Transcatheter aortic valve implantation: General anesthesia using transesophageal echocardiography does not decrease the incidence of paravalvular leaks compared to sedation alone |
title_sort |
transcatheter aortic valve implantation: general anesthesia using transesophageal echocardiography does not decrease the incidence of paravalvular leaks compared to sedation alone |
publisher |
Wolters Kluwer Medknow Publications |
series |
Annals of Cardiac Anaesthesia |
issn |
0971-9784 |
publishDate |
2018-01-01 |
description |
Background: Transcatheter aortic valve implantation (TAVI) is a valid option for patients with severe aortic stenosis judged to be at high surgical risk. For this procedure, there is no agreement on the appropriate type of anesthesia. Sedation offers several advantages, but general anesthesia (GA) leads to less paravalvular leaks (PVLs) probably because of the transesophageal echocardiography (TEE) guidance. The objective was to compare the incidence of PVL among patients receiving conscious sedation (TAVI-S) and patients receiving GA (TAVI-GA). We made the hypothesis that a referral center does not necessitate TAVI-GA to reduce the incidence of moderate-to-severe PVL. Aim: The primary outcome was the incidence of moderate-to-severe PVL at 30 days after the implantation. Design and Setting: This study design was a retrospective observational trial in a university hospital. Methods: The TAVI-S group underwent the procedure under conscious sedation. In the TAVI-GA group, an endotracheal tube and a TEE probe were inserted. After the valve deployment, PVL was assessed by hemodynamic and fluoroscopic measurements in the TAVI-S group. TEE was also used in the TAVI-GA group to evaluate the presence of PVL. When PVL was moderate or severe according to the Valve Academic Research Consortium criteria. Results: TAVI-S and TAVI-GA were accomplished in 168 (67.5%) and 81 (32.5%) patients, respectively. Our results show no difference between the two groups regarding the incidence and grade of PVL. Conclusion: Performing TAVI under GA with TEE guidance is not associated with a lower incidence of moderate and severe PVL. |
topic |
Conscious sedation general anesthesia paravalvular leaks transcatheter aortic valve replacement transesophageal echocardiography |
url |
http://www.annals.in/article.asp?issn=0971-9784;year=2018;volume=21;issue=3;spage=277;epage=284;aulast=Zaouter |
work_keys_str_mv |
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