GKD Anest Yoð Bak Dern Derg. 2020; 26(3): 139-146 | DOI: 10.5222/GKDAD.2020.93824

Our Anesthetic Managements in Patients Undergoing Transcatheter Aortic Valve Implantation (TAVI): A Retrospective Study

Rukiye Doðan Çakýer¹, Funda Gümüþ Özcan², Serdar Demirgan³, Ertuðrul Okuyan⁴, Aysýn Selcan^3
1Anesthesiology And Reanimation Clinic, Republic Of Turkey Ministry Of Health Hopa State Hospital, Artvin, Turkey
²Department Of Anesthesiology And Reanimation, Republic Of Turkey Ministry Of Health, Baþakþehir Çam And Sakura City Hospital, Ýstanbul, Turkey
³Department Of Anesthesiology And Reanimation, Republic Of Turkey Ministry Of Health, Science, Baðcýlar Education And Research Hospital, Ýstanbul, Turkey
⁴Department Of Cardiology, Republic Of Turkey Ministry Of Health, Science, Baðcýlar Education And Research Hospital, Ýstanbul, Turkey

INTRODUCTION: Transcatheter Aortic Valve Implantation (TAVI) procedure is a minimally invasive technique that have been applied in aortic stenosis pathologies which carry high-risk for conventional surgery. Although there is no definitive consensus on anesthesic applications, general, local anesthesic and sedation techniques are being used. In this study, we aimed to evaluate our anesthesia methods used in TAVI procedures, and their effects on results.
METHODS: The archive records of patients who underwent TAVI procedure due to the severe aortic stenosis between 2013 and 2017 were analyzed. Anesthesic approaches, features of the procedure, and patient outcomes were evaluated.
RESULTS: Of the 100 (50 women/50 men) patients who underwent TAVI, 15 had general anesthesia (GA) (15%), and 49 had local anesthesia with sedation (LS) (49%), and 36 had local anesthesia with monitorized anesthesia care (LM) (36%). In the LM group, the anesthesia and procedure times were significantly shorter compared to the GA and LS groups (p<0.05). Vasoactive agenst, and fluid infusions were used more frequently and intensive care (ICU) stay were prolonged in the GA (p<0.05). While the 30-day mortality was 14% in all groups, the mortality rate in the GA was significantly higher than the LS and LM (p=0.007).
DISCUSSION AND CONCLUSION: With an increase in technological advances and experience, the need GA for TAVI has decreased and the anesthesia technique has shifted sharply to applications of LS and LM with the advantages they provided. However, regardless of the anesthesia technique, all patients should be followed up closely in the intraoperative period for good patient outcomes.

Keywords: Transcatheter aortic valve implantation, general anesthesia, local anesthesia, sedation, monitorized anesthesia

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Transkateter Aort Kapak Ýmplantasyonu (TAVÝ) Ýþlemlerinde Anestezi Yöntemlerimiz: Retrospektif Çalýþma

Rukiye Doðan Çakýer¹, Funda Gümüþ Özcan², Serdar Demirgan³, Ertuðrul Okuyan⁴, Aysýn Selcan^3
1Tc. Saðlýk Bakanlýðý Hopa Devlet Hastanesi, Anesteziyoloji Ve Reanimasyon Kliniði, Artvin, Türkiye
²Tc Saðlýk Bakanlýðý Baþakþehir Çam Ve Sakura Þehir Hastanesi, Anesteziyoloji Ve Reanimasyon Kliniði, Ýstanbul, Türkiye
³Saðlýk Bilimleri Üniversitesi Baðcýlar Eðitim Ve Araþtýrma Hastanesi, Anesteziyoloji Ve Reanimasyon Kliniði, Ýstanbul, Türkiye
⁴Saðlýk Bilimleri Üniversitesi Baðcýlar Eðitim Ve Araþtýrma Hastanesi, Kardiyoloji Kliniði, Ýstanbul, Türkiye

GÝRÝÞ ve AMAÇ: There were no significant differences between GDWR and CBR methods except for small differences. Both methods were found to be effective and safe.
YÖNTEM ve GEREÇLER: Kasým 2013 - Aralýk 2017 tarihleri arasýnda ciddi aort darlýðý nedeniyle kardiyoloji kliniði tarafýndan TAVÝ iþlemi uygulanan hastalarýn arþiv kayýtlarý incelenerek, uygulanan anestezi yaklaþýmlarý, iþleme ait özellikler ve hasta sonuçlarý deðerlendirildi.
BULGULAR: 100 (50 kadýn/50 erkek) TAVÝ olgusunun 15’ine genel anestezi (GA), 49’una lokal anestezi-sedasyon (LS), 36’sýna lokal anestezi-monitörize anestezi bakýmý (LM) uygulanmýþtý. LM grubunda, anestezi ve iþlem süreleri, GA ve LS gruplarýna göre anlamlý þekilde kýsaydý (p<0.05). Vazoaktif ajan, sývý infüzyonu ve yoðun bakým (YBÜ) kalýþ süreleri GA grubunda yüksekti (p<0.05). Otuz günlük mortalite tüm gruplarda %14 iken, GA grubunda mortalite oraný LS ve LM gruplarýndan anlamlý derecede yüksek bulundu (p=0.007).
TARTIÞMA ve SONUÇ: Teknolojik ilerlemeler ve deneyimlerin artýþýyla, TAVÝ için GA gereksinimi azalmýþ ve saðladýðý avantajlar ile keskin bir þekilde LS ve LM uygulamalarýna kaymýþtýr. Ancak, iyi hasta sonuçlarý için anestezi tekniðinden baðýmsýz olarak, intraoperatif dönemde tüm hastalar yakýn takip edilmelidir.

Anahtar Kelimeler: Transkateter aort kapak implantasyonu, genel anestezi, lokal anestezi, sedasyon, monitörize anestezi

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