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Minimum-incision trans-subclavian transcatheter aortic valve replacement with regional anesthesia

      Highlights

      • There were no vascular complications and disabling strokes the regional anesthesia (RA) group.
      • Patent ipsilateral internal thoracic artery graft and dialysis fistula were not contraindications.
      • Procedural and in-hospital outcomes were comparable between the two groups.
      • Intraoperative hemodynamics were significantly stable in the RA group.
      • Intensive care unit and hospital stay were significantly shortened in the RA group.

      Abstract

      Background

      Minimum-incision trans-subclavian transcatheter aortic valve replacement (MITS-TAVR) is usually performed in patients who are contraindicated for transfemoral TAVR, under regional anesthesia (RA). This study aimed to evaluate the safety and efficacy of MITS-TAVR under RA compared to MITS-TAVR under general anesthesia (GA).

      Methods

      This single-center observational study included 44 consecutive patients who underwent MITS-TAVR under RA (RA group, n = 19) and GA (GA group, n = 25). RA was achieved using an ultrasound-guided nerve block.

      Results

      The rates of respiratory disease (RA vs. GA, 36.8 % vs. 4.0 %; p < 0.01) and dialysis (79.0 % vs. 0 %; p < 0.01) were significantly higher in the RA group. STS score was significantly higher in the RA group (RA vs. GA, 10.8 ± 1.06 % vs. 7.87 ± 0.93 %; p < 0.01). Both groups had a 100 % procedural success rate. The two groups showed comparable operation room stay times (RA vs. GA, 160 ± 6.96 min vs. 148 ± 5.90 min; p = 0.058). The mean rate of change in blood pressure, used as an index of hemodynamic stability, was significantly lower in the RA group (RA vs. GA, 19.0 ± 3.4 % vs. 35.5 ± 3.0 %; p < 0.01). No in-hospital deaths occurred in either group. One case of minor dissection occurred in the GA group (RA vs.GA, 0 % vs. 4.0 %, p = 0.378). The intensive care unit stay (RA vs. GA, 0.21 ± 0.11 days vs. 1.24 ± 0.10 days; p < 0.01) and hospital stay (RA vs. GA, 7.00 ± 1.73 days vs. 12.2 ± 1.44 days; p < 0.01) were significantly shorter in the RA group.

      Conclusions

      MITS-TAVR under RA is safe and effective and might be a promising alternative approach. It could ensure intraoperative hemodynamic stability and shorten intensive care unit and hospital stays.

      Graphical abstract

      Abbreviations:

      TAVR (transcathter aortic valve replacement), AS (aortic stenosis), TF (transfemoral), TS (trans-subclavian), SA (subclavian artery), GA (general anesthesia), MITS-TAVR (minimum-incision trans-subclaviantranscathter aortic valve replacement), ICU (intensive care unit), RA (regional anesthesia), MBP (mean blood pressure), OR (operating room)

      Keywords

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