Frontiers in cardiovascular medicine · 2025
Clinical outcomes of monitored anesthesia care vs. general anesthesia in transfemoral transcatheter aortic valve implantation: a single-center retrospective study.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Zhang Haoran, Chen Tao, Yu Bo, Zhang Donghui
Аннотация
BACKGROUND: Transcatheter aortic valve implantation (TAVI) has become a preferred treatment for severe aortic stenosis in high-risk patients. In China, general anesthesia (GA) remains the standard; however, monitored anesthesia care (MAC) offers a less-invasive alternative. In this study, we compared the outcomes between MAC and GA in transfemoral TAVI.
METHODS: We retrospectively analyzed the data from 106 consecutive patients (54 MAC, 52 GA) who underwent TAVI at a The Second Affiliated Hospital of Harbin Medical University from January 2021 to November 2023. MAC involved administration of a combination of local anesthesia with dexmedetomidine/remifentanil sedation, whereas GA involved endotracheal intubation. We compared procedural metrics, complications, and lengths of hospital stays.
RESULTS: The baseline characteristics were comparable between the groups (mean age: 70.3 ± 7.3 years, 46% with reduced ejection fraction). The MAC group showed shorter procedure times (102 ± 25 vs. 145 ± 42 min, p < 0.0001) and hospital stays (10.5 ± 3.7 vs. 14.1 ± 5.1 days, p < 0.0001), compared with the GA group. Safety outcomes were similar between the groups: 30-day mortality (5.8% vs. 7.4% in the MAC and GA groups, respectively, p = 0.734), stroke (1.9% in both groups), and major vascular complications (3.8% vs. 5.6%). The GA group had higher valve-in-valve rates (13% vs. 1.9%, p = 0.024) and postoperative hypotension (4 vs. 0 patients), compared with the MAC group. Pacemaker implantation was more frequent in the MAC group vs. the GA group (13% vs. 3.8%, p = 0.229).
CONCLUSIONS: The use of MAC for TAVI is comparably safe to using GA, with potential advantages in recovery speed and resource utilization. A heart team approach, including cardiac anesthesiologists, is critical for optimal patient selection.
METHODS: We retrospectively analyzed the data from 106 consecutive patients (54 MAC, 52 GA) who underwent TAVI at a The Second Affiliated Hospital of Harbin Medical University from January 2021 to November 2023. MAC involved administration of a combination of local anesthesia with dexmedetomidine/remifentanil sedation, whereas GA involved endotracheal intubation. We compared procedural metrics, complications, and lengths of hospital stays.
RESULTS: The baseline characteristics were comparable between the groups (mean age: 70.3 ± 7.3 years, 46% with reduced ejection fraction). The MAC group showed shorter procedure times (102 ± 25 vs. 145 ± 42 min, p < 0.0001) and hospital stays (10.5 ± 3.7 vs. 14.1 ± 5.1 days, p < 0.0001), compared with the GA group. Safety outcomes were similar between the groups: 30-day mortality (5.8% vs. 7.4% in the MAC and GA groups, respectively, p = 0.734), stroke (1.9% in both groups), and major vascular complications (3.8% vs. 5.6%). The GA group had higher valve-in-valve rates (13% vs. 1.9%, p = 0.024) and postoperative hypotension (4 vs. 0 patients), compared with the MAC group. Pacemaker implantation was more frequent in the MAC group vs. the GA group (13% vs. 3.8%, p = 0.229).
CONCLUSIONS: The use of MAC for TAVI is comparably safe to using GA, with potential advantages in recovery speed and resource utilization. A heart team approach, including cardiac anesthesiologists, is critical for optimal patient selection.