Author + information
- Received May 27, 2016
- Revision received August 2, 2016
- Accepted August 11, 2016
- Published online October 24, 2016.
- S1936879816313164-d05e8da58143050af01c47226873293eNicolas Debry, MDa,
- S1936879816313164-6e1496561989791cc644e044d6cb2b0bCédric Delhaye, MDa,
- S1936879816313164-e12a3382cf3a92c7afde42737b5ff3beAlexandre Azmoun, MDb,
- S1936879816313164-9f6a4e2a6acc2572d0a7f26d15bd1d67Ramzi Ramadan, MDb,
- S1936879816313164-94a601fbb4ebf1a5a3086e28257478e1Sahbi Fradi, MDb,
- S1936879816313164-f7ddc8ecc96e36173b4834c8c69fb345Philippe Brenot, MDb,
- S1936879816313164-8de0ae2d6efdb9bda4c74e1f7be8c987Arnaud Sudre, MDa,
- S1936879816313164-4b2779b5f63c163894448f804e42259cMouhamed Djahoum Moussa, MDa,
- S1936879816313164-1d89a3a268baebf88bf7199a2278dc1fDidier Tchetche, MDc,
- S1936879816313164-8253f294a5af5a5403d155591c420106Said Ghostine, MDb,
- S1936879816313164-dc94e6e86982a722efaf58282ff097e1Darren Mylotte, MDd and
- S1936879816313164-fda91c7007aa45cb0efa898292e3539cThomas Modine, MD, PhDa,∗ ()
- aHeart Team, Cardiology and Cardiovascular Surgery Departments, Institut Cardiopulmonaire, CHRU Lille, Lille, France
- bHeart Team, Cardiology and Cardiovascular Surgery Departments, Centre Médico-Chirurgical Marie Lannelongue (CCML), Le Plessis-Robinson, France
- cClinique Pasteur, Toulouse, France
- dGalway University Hospitals, Galway, Ireland
- ↵∗Reprint requests and correspondence:
Dr. Thomas Modine, Boulevard du Professeur Jules Leclercq, Hôpital Cardiologique, CHRU Lille, Lille 59000, France.
Objectives The study sought to assess the safety and efficacy of a minimally invasive strategy (MIS) (local anesthesia and conscious sedation) compared to general anesthesia (GA) among the largest published cohort of patients undergoing transcarotid transcatheter aortic valve replacement (TAVR).
Background Transcarotid TAVR has been shown to be feasible and safe. There is, however, no information pertaining to the mode anesthesia in these procedures.
Methods Between 2009 and 2014, 174 patients underwent transcarotid TAVR at 2 French centers. All patients were unsuitable for transfemoral TAVR due to severe peripheral vascular disease. An MIS was undertaken in 29.8% (n = 52) and GA in 70.1% (n = 122). One-year clinical outcomes were available in all patients and were described according to the Valve Academic Research Consortium-2 consensus.
Results Transcarotid vascular access and transcatheter valve deployment was successful in all cases. Thirty-day mortality was 7.4% (n = 13) and 1-year all-cause and cardiovascular mortality were 12.6% (n = 22) and 8.0% (n = 14), respectively. According to the type of anesthesia, there was no between group difference in 30-day mortality (GA 7.3% vs. MIS 7.6%; p = 0.94), 1-year mortality (GA 13.9% vs. MIS 9.6%; p = 0.43), 1-month clinical efficacy (GA 85.2% vs. MIS 94.2%; p = 0.09), and early safety (GA 77.8% vs. MIS 86.5%; p = 0.18). There were 10 (5.7%) periprocedural cerebrovascular events: 4 strokes (2.2%) and 6 transient ischemic attacks (3.4%) among those treated with GA. There was neither stroke nor transient ischemic attack in the MIS group (p < 0.001).
Conclusions The transcarotid approach for TAVR is feasible using general or local anesthesia. A higher rate of perioperative strokes was observed with GA.
- aortic stenosis
- general anesthesia
- local anesthesia
- transcarotid access
- transcatheter aortic valve replacement
Dr. Sudre has served as a consultant for Edwards Lifesciences and Medtronic. Dr. Modine has served as a proctor and consultant for Medtronic and Microport. Dr. Mylotte has served as a proctor for Medtronic and Microport. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 27, 2016.
- Revision received August 2, 2016.
- Accepted August 11, 2016.
- American College of Cardiology Foundation