Author + information
- Received October 23, 2017
- Revision received December 14, 2017
- Accepted December 19, 2017
- Published online March 19, 2018.
- Oliver Husser, MD, PhDa,∗ (, )
- Buntaro Fujita, MDb,
- Christian Hengstenberg, MDa,c,d,
- Christian Frerker, MDe,
- Andreas Beckmann, MDf,
- Helge Möllmann, MDg,
- Thomas Walther, MDh,
- Raffi Bekeredjian, MDi,
- Michael Böhm, MDj,
- Costanza Pellegrini, MDa,
- Sabine Bleiziffer, MDk,l,
- Rüdiger Lange, MDk,l,
- Friedrich Mohr, MDm,
- Christian W. Hamm, MDn,o,
- Timm Bauer, MDn,
- Stephan Ensminger, MDb,
- on behalf of the GARY Executive Board
- aKlinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
- bDepartment for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
- cDivision of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
- dDeutsches Zentrum für Herz- und Kreislauf-Forschung e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
- eDepartment of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
- fDeutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie, Berlin, Germany
- gDepartment of Cardiology, St. Johannes Hospital, Dortmund, Germany
- hDepartment of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany
- iCenter for Internal Medicine, Heidelberg University Hospital, Heidelberg, Germany
- jKlinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
- kKlinik für Herz- und Gefäßchirurgie, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
- lInsure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
- mLeipzig Heart Center, University of Leipzig, Leipzig, Germany
- nDepartment of Medical Clinic I, University of Giessen, Giessen, Germany
- oDepartment of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany
- ↵∗Address for correspondence:
PD Dr. med. Oliver Husser, Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany.
Objectives The aims of this study were to report on the use of local anesthesia or conscious sedation (LACS) and general anesthesia in transcatheter aortic valve replacement and to analyze the impact on outcome.
Background Transcatheter aortic valve replacement can be performed in LACS or general anesthesia. Potential benefits of LACS, such as faster procedures and shorter hospital stays, need to be balanced with safety.
Methods A total of 16,543 patients from the German Aortic Valve Registry from 2011 to 2014 were analyzed, and propensity-matched analyses were performed to correct for potential selection bias.
Results LACS was used in 49% of patients (8,121 of 16,543). In hospital, LACS was associated with lower rates of low-output syndrome, respiratory failure, delirium, cardiopulmonary resuscitation, and death. There was no difference in paravalvular leakage (II+) between LACS and general anesthesia in the entire population (5% vs. 4.8%; p = 0.76) or in the matched population (3.9% vs. 4.9%, p = 0.13). The risk for prolonged intensive care unit stay (≥3 days) was significantly reduced with LACS (odds ratio: 0.82; 95% confidence interval [CI]: 0.73 to 0.92; p = 0.001). Thirty-day mortality was lower with LACS in the entire population (3.5% vs. 4.9%; hazard ratio [HR]: 0.72; 95% CI: 0.60 to 0.86; p < 0.001) and in the matched population (2.8% vs. 4.6%; HR: 0.6; 95% CI: 0.45 to 0.8; p < 0.001). However, no differences in 1-year mortality between both groups in the entire population (16.5% vs. 16.9%; HR: 0.93; 95% CI: 0.85 to 1.02; p = 0.140) and in the propensity-matched population (14.1% vs. 15.5%; HR: 0.90; 95% CI: 0.78 to 1.03; p = 0.130) were observed.
Conclusions Use of LACS in transcatheter aortic valve replacement is safe, with fewer post-procedural complications and lower early mortality, suggesting its broad application.
This work was supported by unrestricted grants from medical device companies (Edwards Lifesciences, Medtronic, Symetis, JenaValve Technology, Liva-Nova, St. Jude Medical, and Direct Flow Medical), the German Heart Foundation, the German Society of Cardiology, and the German Society of Thoracic and Cardiovascular Surgery. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 23, 2017.
- Revision received December 14, 2017.
- Accepted December 19, 2017.
- 2018 American College of Cardiology Foundation