Author + information
- Michal Droppa1,
- Thomas Katzenberger1,
- Roland Krause1,
- Oliver Borst1,
- Dominik Rath1,
- Karin Müller1,
- Gawaz Meinrad1 and
- Tobias Geisler1
Transfemoral aortic valve replacement (TAVR) is a standard therapy for aortic valve stenosis in high-risk patients. Performing the procedure under local anesthesia was shown to be safe and effective compared to general anesthesia. However, the exact perioperative setting concerning procedure team composition vary according to local practise and regulations.
TAVR was performed in local anesthesia with reduced heart team (RHT) approach at our centre before September 2015. The team consisted of two interventional cardiologists, echocardiographist and two cardiac catheterization laboratory nurses. Surgical team consisted of cardiac surgeon, anesthesiologist, cardiovascular perfusionist, surgical nurse and nurse anesthetist, were available only on call for the case of conversion to the open surgery. After September 2015, a change of setting was required according to the new national mandatory guidelines (GBA). We performed the procedures in complete heart team (CHT - both teams together as described above). We retrospectively analyzed periprocedural and in-hospital outcome of patients comparing both settings.
From February 2014 till May 2017, 529 patients underwent TAVR procedure in local anesthesia. 291 patients were treated by RHT, whereas 238 patients were treated by CHT. Both groups were comparable according baseline characteristics and were in high perioperative risk. There were no significant differences in periprocedural, procedure related and in-hopital mortality, as well as in conversion to open heart or vascular surgery. Overall major vascular complication were slightly more frequent in CHT setting, however there were no significant differences in their management (surgically vs. interventional, table 1).
|N=529||Reduced team N=291 (55%)||Complete team N=238 (45%)||P|
|Procedural success||290 (99.7%)||235 (98.7%)||0.33|
|Periprocedural mortality||2 (0.7%)||2 (0.8%)||1.0|
|Procedure related mortality||9 (3.1%)||5 (2.1%)||0.48|
|In-hospital mortality||14 (4.8%)||12 (5.0%)||0.90|
|Conversion to open heart surgery||2 (0.7%)||1 (0.4%)||1.0|
|Immediate vessel surgery||2 (0.7%)||1 (0.4%)||1.0|
|Major vascular complication||20 (6.9%)||29 (12.2%)||0.04|
|managed interventionally||17 (85.0%)||23 (79.3%)||0.72|
|managed surgically||3 (15.0%)||6 (20.7%)||0.72|
TAVR in local anesthesia can be safely performed in RHT. We didn’t observe difference in fatal periprocedural complication and mortality in comparison with CHT.
STRUCTURAL: Valvular Disease: Aortic