Transkateter aort kapak replasmanı için genel anesteziye karşı lokal anestezi

Yıl 2023, Cilt: 3 Sayı: 2, 68 - 75, 21.08.2023

Serhat Günlü , Fethullah Kayan , Tuncay Güzel , Adem Aktan , Muhammed Raşit Tanırcan , Mehmet Zülkif Karahan

https://doi.org/10.58961/hmj.1317761

Öz

Arka plan/Amaçlar: Transkateter aort kapak replasmanı (TAVR), anestezi yönetimi açısından önemli zorluklar doğurur. TAVR prosedürleri için daha güvenli anestezi türü konusunda fikir birliği yoktur. Sedasyonlu lokal anestezi (LAS) altında transfemoral yaklaşımla yapılan TAVR'nin genel anesteziye (GA) karşı etkinlik ve güvenilirliğini değerlendirmeyi amaçladık.

Yöntemler: Bu gözlemsel ve retrospektif analiz, 2016'dan 2022'ye planlı olarak başvuran ve Transfemoral TAVR uygulanan bireyleri içermektedir. Etkinlik ve güvenlik sonuçları 30 günde değerlendirildi. Bireyler GA ve LAS olmak üzere iki gruba ayrıldı. Hastanede yatışları sırasında demografik özellikler ve prosedürel veriler kaydedildi.
Bulgular: 62'sine (%53.9) LAS, 53'üne GA (%46.1) olmak üzere 115 hasta dahil edildi. Çalışmaya yaş ortalaması 83,2±5,7 olan 59 kadın (%48.8) hasta katıldı. Transfemoral yaklaşımla 115 hastanın 100'üne (%86.9) başarılı TAVR işlemi uygulandı. Ortalama işlem süresi 136.7±46.7 dakika olup GA'ya karşı LAS yapılan hastalarda işlem süresi daha kısaydı (p=0.001). Gruplar arasında floroskopi süresi, kontrast ve radyasyon dozu açısından fark yoktu (p>0.05). 2 hastada (%3.2) önemli vasküler komplikasyonlar acil cerrahi girişim gerektirdi ve anestezi tekniğinde değişiklik yapılmasını gerektirdi. Genel 30 günlük mortalite %5.2 idi ve gruplar arasında önemli bir fark yoktu (GA %7.5'e karşılık LAS %3.2, p =0.28). GA, LAS'tan önemli ölçüde daha uzun YBÜ ve toplam hastanede kalış süresine sahipti (sırasıyla p=0.009 ve p =0.004).
Sonuç: Çalışmamızda LAS kullanılarak transfemoral yoldan TAVR, GA'ya bir alternatifti.

Anahtar Kelimeler

Lokal anestezi, aort stenozu, transfemoral TAVR

Local against general anesthesia for transcatheter aortic valve replacement

Öz

Background/Aims: Transcatheter aortic valve replacement (TAVR) poses significant challenges concerning anesthesia management. There is no consensus on the type of safer anesthesia for TAVR procedures. We aimed to evaluate the effectiveness and safety of TAVR performed with trans-femoral approach under local anesthesia with sedation (LAS) against general anesthesia (GA).
Methods: This observational and retrospective analysis included individuals who were admitted on a planned basis from 2016 to 2022 and underwent Transfemoral TAVR. Effectiveness and safety outcomes were evaluated at 30 days. İndividuals were separated into two groups: GA and LAS. Demographic characteristics and procedural data were recorded during hospitalization.
Results: 115 patients were included, of whom 62 (53.9%) received LAS and 53 received GA (46.1%). 59 female (48.8%) patients with a mean age of 83.2±5.7 participated in the study. Successful TAVR procedure was performed in 100 (86.9%) of 115 patients with the transfemoral approach. The mean procedure time was 136.7±46.7 minutes, and the procedure time was shorter in patients who underwent LAS against GA (p=0.001). There were no differences among the groups including fluoroscopy time, contrast, and radiation dose (p>0.05). In 2 patients (3.2%), significant vascular complications necessitated immediate surgical intervention, necessitating a change in the anesthesia technique. Overall 30-day mortality was 5.2%, with no significant differences among the groups (GA 7.5% vs. LAS 3.2%, p =0.28). GA had substantially longer ICU and total hospitalization stays than LAS (p=0.009 and p =0.004, respectively).
Conclusions: In our study, TAVR via the transfemoral route using LAS was an alternative for GA.

Anahtar Kelimeler

Local anesthesia, aortic stenosis, trans-femoral TAVR

Kaynakça

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