Document Detail

Effect of thoracic epidural analgesia on clinical outcomes following transapical transcatheter aortic valve implantation.
MedLine Citation:
PMID:  22791654     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To determine the impact of perioperative thoracic epidural analgesia (TEA) on acute and late outcomes following transapical transcatheter aortic valve implantation (TA-TAVI).
PATIENTS AND INTERVENTION: A total of 135 consecutive patients who underwent TA-TAVI were included. All patients received catheter-based pain control, either via TEA (TEA group, n=74) or intercostal local analgesia with a catheter placed at the surgical incision site (non-TEA group, n=61), depending on the preference of the anaesthesiologist responsible for the case.
MAIN OUTCOME MEASURES: Pain level during early postoperative period (verbal rating scale from 1 to 10), 30-day/in-hospital complications and mortality, and 1-year mortality.
RESULTS: There were no differences in baseline or procedural characteristics between groups except for a lower left ventricular ejection fraction in the TEA group. The maximal pain score related to thoracotomy in the postoperative period was higher in the non-TEA group as compared with the TEA group (4 (IQR: 3-5)) vs 2 (IQR: 1-3), p<0.001). Non-TEA was associated with a higher rate of pulmonary complications (p<0.05 for nosocomial pneumonia, reintubation and tracheostomy). The 30-day/in-hospital mortality rate was higher in the non-TEA group (22.9% vs 2.7% in the TEA group, p<0.001). At 1-year follow-up, overall mortality remained higher in the non-TEA group (31.1%) compared with the TEA group (10.8%), p=0.005. Similar periprocedural and late results were obtained in a propensity score-matched analysis that included 100 matched patients. In the multivariable analysis, STS score (p=0.027) and absence of TEA (p=0.039) were independent predictors of increased cumulative late mortality.
CONCLUSIONS: TEA provided superior analgesia following TA-TAVI, and was associated with a dramatic reduction in periprocedural respiratory complications, and both, short- and long-term mortality. These results highlight the importance of obtaining optimal analgesia following TA-TAVI to improve the results associated with this procedure.
Ignacio J Amat-Santos; Eric Dumont; Jacques Villeneuve; Daniel Doyle; Michel Rheault; Dominique Lavigne; Jerôme Lemieux; André St-Pierre; Michael Mok; Marina Urena; Luis Nombela-Franco; Steve Blackburn; Mathieu Simon; Christine Bourgault; José Luis Carrasco; Philippe Pibarot; Melanie Côté; Robert Delarochellière; David J Cohen; Josep Rodés-Cabau
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-07-11
Journal Detail:
Title:  Heart (British Cardiac Society)     Volume:  98     ISSN:  1468-201X     ISO Abbreviation:  Heart     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-10-22     Completed Date:  2013-01-08     Revised Date:  2013-03-08    
Medline Journal Info:
Nlm Unique ID:  9602087     Medline TA:  Heart     Country:  England    
Other Details:
Languages:  eng     Pagination:  1583-90     Citation Subset:  AIM; IM    
Quebec Heart Lung Institute, Laval University, Quebec City, Canada.
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MeSH Terms
Aged, 80 and over
Analgesia, Epidural*
Aortic Valve Stenosis / mortality,  surgery*
Cardiac Catheterization / methods*
Follow-Up Studies
Heart Valve Prosthesis Implantation / methods*,  mortality
Hospital Mortality / trends
Risk Factors
Survival Rate / trends
Treatment Outcome
Erratum In:
Heart. 2013 Feb;99(4):287

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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