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Anestesia general versus sedación para implante transcatéter de válvula aórtica: estudio retrospectivo en Hospital Colombiano
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Autores
Hurtado Peña, Pedro Arturo
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Fecha
2020-07-31
Directores
Montes Romero, Félix Ramón
Durán-Torres, Felipe
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Editor
Universidad del Rosario
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Resumen
Introducción: El TAVI surge como alternativa en el tratamiento de pacientes con estenosis aórtica severa sintomática, con riesgo quirúrgico prohibitivo o alto. En Colombia no hay estudios que muestren los beneficios o desventajas de la sedación en pacientes llevados a TAVI. El objetivo del presente estudio es comparar los tiempos de estancia intrahospitalaria y los desenlaces clínicos obtenidos en pacientes con estenosis aórtica severa o disfunción protésica aórtica que son llevados a TAVI bajo anestesia general con los encontrados en pacientes llevados a TAVI bajo sedación. Metodología: Estudio de cohorte retrospectivo en pacientes llevados a TAVI por vía transfemoral en la Fundación Cardioinfantil, entre el período 2016 - 2020 bajo anestesia general o sedación. Se evaluaron los tiempos de estancia en UCI y estancia hospitalaria, así como los desenlaces medidos por el VARC. Resultados: 158 procedimientos fueron incluidos, 82 (51.8%) bajo sedación y 76 (48.2%) bajo anestesia general. Estancia en UCI de 1.68 días en grupo sedados (1.4 a 1.9 IC 95%) vs 2.37 días para grupo de anestesia general (2.0-2.7 IC95%) (p = 0.002). Estancia hospitalaria posterior a TAVI de 3.37 en grupo sedación (2.9-3.8 IC95%) vs 4.38 días en el grupo de anestesia general (3.8-5.0 IC95%) (p = 0.009). No se identificaron diferencias en el VARC. Conclusiones: La implementación de la sedación en pacientes sometidos a TAVI transfemoral, se asocia a la disminución del tiempo en UCI y en estancia hospitalaria postoperatoria. No se evidenciaron diferencias en la incidencia de complicaciones postoperatorias considerados en el VARC.
Abstract
Introduction: Transcatheter aortic valve implantation (TAVI) is recommended in patients with severe symptomatic aortic stenosis with prohibitive and high surgical risk. It is also an alternative in patients with intermediate surgical risk. Despite the growth in the number of TAVI procedures performed, the optimal anesthetic management has not been established. At our institution, TAVI was conventionally performed under general anesthesia (GA), yet in December 2017, a sedation management protocol was implemented. The objective of this study was to compare postinterventional outcomes of sedation with those of GA in patients undergoing transfemoral TAVI. Methods: This was a single-center, retrospective, before-after study. All consecutive patients who underwent transfemoral TAVI from January 2016 through March 2020 were stratified into two groups according to whether they received GA (before December 2017) or sedation (after December 2017) during the procedure. The primary endpoints were intensive care unit (ICU) and post-procedural hospital length of stays (LOS). Secondary endpoints were registered according to the Valve Academic Research Consortium-2 (VARC-2) criteria. In addition, the incidence of vasopressor use, procedural time, and anesthesia time was recorded. Data were analyzed by unpaired t-test with Welch´s correction, Fisher´s exact test or Chi-square as appropriate. P < 0.05 was considered statistically significant. Results: A total of 158 patients (53% male, mean age 79 years) underwent transfemoral TAVI under sedation (n = 82) or GA (n =76). Baseline characteristics are shown in Table 1. Seven patients (8.5%) in the sedation group required conversion to GA. Administration of sedation was associated with a significant decrease in UCI (1.7 vs 2.4 days, p = 0.002) and post-procedural hospital (3.4 vs 4.4 days, p = 0.009) LOS (Figure 1). The sedation group had a significantly shorter anesthesia time and less vasopressor requirement. Procedural time and VARC-2 endpoints were not significantly different (Table 1). Conclusions: Implementation of a sedation protocol for patients undergoing transfemoral TAVI was associated with improved ICU and hospital LOS. The incidence of important clinical endpoints was not affected by the anesthesia technique.
Palabras clave
Anestesia general , Sedación , TAVI , Transfemoral
Keywords
General anesthesia , Sedation , TAVI
