Effect of thoracic epidural analgesia on clinical outcomes following transapical transcatheter aortic valve implantation

Authors: Amat Santos, Ignacio J.Dumont, ÉricVilleneuve, JacquesDoyle, DanielRheault, MichelLavigne, DominiqueLemieux, JérômeSt-Pierre, AndréMok, MichaelUrena Alcazar, MarinaNombela-Franco, LuisBlackburn, SteveSimon, MathieuBourgault, ChristineCarrasco, José LuisPibarot, PhilippeCôté, MélanieDeLarochellière, Robert; Cohen, David J.; Rodés-Cabau, Josep
Abstract: 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.
Document Type: Article de recherche
Issue Date: 1 November 2012
Open Access Date: Restricted access
Document version: VoR
Permalink: http://hdl.handle.net/20.500.11794/7908
This document was published in: Heart, Vol. 98 (21), 1583-1590 (2012)
https://doi.org/10.1136/heartjnl-2012-302185
BMJ
Alternative version: 10.1136/heartjnl-2012-302185
22791654
Collection:Articles publiés dans des revues avec comité de lecture

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