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Transcatheter aortic valve implantation: General anesthesia using transesophageal echocardiography does not decrease the incidence of paravalvular leaks compared to sedation alone
Cédrick Zaouter1, Sara Smaili1, Lionel Leroux2, Guillaume Bonnet2, Sébastien Leuillet3, Alexandre Ouattara4
1 Department of Anaesthesia and Intensive Care II, Bordeaux University Hospital, CHU de Bordeaux, 33000 Bordeaux, France
2 Department of Cardiology, Bordeaux University Hospital, CHU de Bordeaux, 33000 Bordeaux, France
3 Biofortis, Mérieux, NutriSciences Company, Saint-Herblain, France
4 Department of Anaesthesia and Intensive Care II, Bordeaux University Hospital, CHU de Bordeaux, 33000 Bordeaux; University of Bordeaux, INSERM, UMR 1034, Biology of Cardiovascular Diseases, Pessac, France
Cédrick Zaouter
Department of Anaesthesia and Critical Care II, Magellan Medico-Surgical Center, F-33000 Bordeaux
DOI: 10.4103/aca.ACA_204_17
Zaouter C
Smaili S
Leroux L
Bonnet G
Leuillet S
Ouattara A
Conscious sedation
paravalvular leaks
transesophageal echocardiography
Background: Transcatheter aortic valve implantation (TAVI) is a valid option for patients with severe aortic stenosis judged to be at high surgical risk. For this procedure, there is no agreement on the appropriate type of anesthesia. Sedation offers several advantages, but general anesthesia (GA) leads to less paravalvular leaks (PVLs) probably because of the transesophageal echocardiography (TEE) guidance. The objective was to compare the incidence of PVL among patients receiving conscious sedation (TAVI-S) and patients receiving GA (TAVI-GA). We made the hypothesis that a referral center does not necessitate TAVI-GA to reduce the incidence of moderate-to-severe PVL. Aim: The primary outcome was the incidence of moderate-to-severe PVL at 30 days after the implantation. Design and Setting: This study design was a retrospective observational trial in a university hospital. Methods: The TAVI-S group underwent the procedure under conscious sedation. In the TAVI-GA group, an endotracheal tube and a TEE probe were inserted. After the valve deployment, PVL was assessed by hemodynamic and fluoroscopic measurements in the TAVI-S group. TEE was also used in the TAVI-GA group to evaluate the presence of PVL. When PVL was moderate or severe according to the Valve Academic Research Consortium criteria. Results: TAVI-S and TAVI-GA were accomplished in 168 (67.5%) and 81 (32.5%) patients, respectively. Our results show no difference between the two groups regarding the incidence and grade of PVL. Conclusion: Performing TAVI under GA with TEE guidance is not associated with a lower incidence of moderate and severe PVL.
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