Publication details

Local and general anaesthesia do not influence outcome of transfemoral aortic valve implantation

Authors	DALL´ARA Gianni ELTCHANINOFF Helene MOAT Neil LAROCHE Cécile GOICOLEA Javier USSIA Gian Paolo KALA Petr WENAWESER Peter ZEMBALA Marian NICKENIG Georg SNOW Thomas PRICE Susanna BARRERO Eduardo Alegria ESTEVEZ-LOUREIRO Rodrigo IUNG Bernard ZAMORANO José Luis SCHULER Gerhard ALFIERI Ottavio PRENDERGAST Bernard LUDMAN Peter WINDECKER Stephan SABATE Manel GILARD Martine WITKOWSKI Adam DANENBERG Haim SCHROEDER Erwin ROMEO Francesco MACAYA Carlos DERUMEAUX Genevieve MATTESINI Alessio TAVAZZI Luigi DI MARIO Carlo
Year of publication	2014
Type	Article in Periodical
Magazine / Source	International Journal of Cardiology
MU Faculty or unit	Faculty of Medicine
Citation
Doi	http://dx.doi.org/10.1016/j.ijcard.2014.09.025
Field	Cardiovascular diseases incl. cardiosurgery
Keywords	Anaesthesia; Transcatheter aortic valve implantation; Aortic valve stenosis; Outcome
Description	Background: There is great variability for the type of anaesthesia used during TAVI, with no clear consensus coming from comparative studies or guidelines. We sought to detect regional differences in the anaesthetic management of patients undergoing transcatheter aortic valve implantation (TAVI) in Europe and to evaluate the relationship between type of anaesthesia and in-hospital and 1 year outcome. Methods: Between January 2011 and May 2012 the Sentinel European TAVI Pilot Registry enrolled 2807 patients treated via a transfemoral approach using either local (LA-group, 1095 patients, 39%) or general anaesthesia (GA-group, 1712 patients, 61%). Results: A wide variation in LA use was evident amongst the 10 participating countries. The use of LA has increased over time (from a mean of 37.5% of procedures in the first year, to 57% in last 6 months, p < 0.01). MI, major stroke aswell as in-hospital death rate (7.0% LAvs 5.3% GA, p = 0.053) had a similar incidence between groups, confirmed in multivariate regression analysis after adjusting for confounders. Dividing our population in tertiles according to the Log-EuroSCORE we found similar mortality under LA, whilst mortality was higher in the highest risk tertile under GA. Survival at 1 year, compared by Kaplan-Meier analysis, was similar between groups (log-rank: p = 0.1505). Conclusions: Selection of anaesthesia appears to be more influenced by national practice and operator preference than patient characteristics. In the absence of an observed difference in outcomes for either approach, there is no compelling argument to suggest that operators and centres should change their anaesthetic practice.