A. Das1, D. M. Strauss1, G. Savulionyte1, N. L. Owen-Simon1, K. J. Oh1, H. A. Cohen1, B. O’Murchu1, B. P. O’Neill1, G. Wheatley1 1Temple University,Cardiovascular Surgery,Philadelpha, PA, USA
Introduction: Optimal anesthetic strategy for transcatheter aortic valve replacement (TAVR) procedures has yet to be determined. Currently, general anesthesia (GA) is the accepted approach in those patients requiring transfemoral vascular access, however emerging data suggests that outcomes can be improved using local anesthesia (LA). The purpose of this study is to compare outcomes of patients with severe, symptomatic aortic valve stenosis undergoing transfemoral TAVR using general versus local anesthesia.
Methods: A retrospective review of patients undergoing TAVR from December 2013 to June 2015 was performed. Institutional Review Board approval was obtained. Demographic information and outcome data were collected regarding type of anesthesia, procedural success, respiratory complications and lengths of stay in the intensive care unit and hospital. Statistical analysis was performed using SPSS Statistics.
Results: A total of 30 patients (12 GA, 18 LA) underwent transfemoral TAVR. Average age for GA patients was 80.6 years and 81.3 years for LA patients (p=0.82). M:F ratio was 1:1 for GA patients, and 5:13 for LA patients (p=0.22). Average Society of Thoracic Surgeons (STS) score for GA patients was 9.6, and 7.8 for LA patients (p=0.30). [Figure 1] Five (41.7%) patients in the GA group had a diagnosis of chronic obstructive pulmonary disease (COPD), and 10 (55.6%) patients in the LA group had COPD (p=0.46). The Medtronic CoreValve was used in 2 patients undergoing GA and 9 patients with LA (p=0.06), while the Edward SAPIEN prosthesis was implanted in 10 patients receiving GA and 9 patients receiving LA. Procedural success was 100% in both groups. Operative times averaged 125.3 (88-207) minutes in the GA group and 109.6 (60-168) minutes in the LA group (p=0.13). No LA patient required conversion to GA. Ten GA patients (83.3%) were extubated in the operating room, while 1 (5.6%) LA patient required intubation on post-operative day 8 due to COPD exacerbation. Average intensive care unit stay (ICU) was 3.1 (1-8) days for GA patients and 2.4 (0-11) days for LA patients (p=0.32). Average hospital stay for GA patients was 6.9 (2-14) days and 5.5 (2-12) days for LA patients (p=0.36). 30-day mortality was 0 in GA group and 5.6% (n=1) in the LA group.
Conclusion: LA for transfemoral TAVR procedures is feasible and yields similar procedural outcomes as GA techniques. Although patients receiving LA had a higher incidence of COPD, fewer of these patients had post-operative respiratory complications and there were shorter ICU and hospital lengths of stay. Future studies will need to compare procedural and total hospital costs between these two anesthetic approaches.
