Key result
Monitored anaesthesia care is favoured over general anaesthesia in ~76% of German TF-TAVI centres.
Why the study?
Generally accepted expert consensus recommendations or guidelines for periprocedural anaesthesia management during TF-TAVI are lacking, and concordance with German national infrastructural regulations required evaluation.
Cross-Sectional (n=54)
Yes
This nationwide survey highlights significant institutional variability in anaesthesia practices for TF-TAVI in Germany, underscoring the need for standardized guidelines.
TF-TAVI anaesthesia practices vary widely across German centres; leaves open optimal strategy pending prospective comparisons.
OBJECTIVES: Transfemoral transcatheter aortic valve implantation (TF-TAVI) is an established therapy for patients with symptomatic aortic stenosis, which requires periprocedural anaesthesia care. In 2015, the German Federal Joint Committee released a directive on minimally invasive heart valve interventions which defines institutional infrastructural requirements in German heart centres. But still generally accepted expert consensus recommendations or national or international guidelines regarding periprocedural anaesthesia management for TF-TAVI are lacking. This nationwide cross-sectional study had two major objectives: first to assess the concordance with existing national regulations regarding infrastructural requirements and second to evaluate the status quo of periprocedural anaesthesia management for patients undergoing TF-TAVI in German heart centres. DESIGN: Multicentre cross-sectional online study to evaluate the periprocedural anaesthesia management. SETTING: In this nationwide cross-sectional study, electronic questionnaires were sent out to anaesthesia departments at TF-TAVI-performing centres in Germany in March 2019. PARTICIPANTS: 78 anaesthesia departments of German heart centres. RESULTS: 54 (69.2%) centres returned the questionnaire of which 94.4% stated to hold regular Heart Team meetings, 75.9% to have ready-to-use heart-lung machines available on-site, 77.8% to have cardiac surgeons and 66.7% to have perfusionists routinely attending throughout TF-TAVI procedures. Regarding periprocedural anaesthesia management, 41 (75.9%) of the participating centres reported to predominantly use 'monitored anaesthesia care' and 13 (24.1%) to favour general anaesthesia. 49 (90.7%) centres stated to use institutional standard operating procedures for anaesthesia. Five-lead ECG, central venous lines, capnometry and intraprocedural echocardiography were reported to be routine measures in 85.2%, 83.3%, 77.8% and 51.9% of the surveyed heart centres. CONCLUSIONS: The concordance with national regulations, anaesthesia management and in-house standards for TF-TAVI vary broadly among German heart centres. According to the opinion of the authors, international expert consensus recommendations and/or guidelines would be helpful to standardise peri interventional anaesthesia care.
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Löser et al. (2021) conducted a cross-sectional in Transfemoral transcatheter aortic valve implantation (TF-TAVI) periprocedural anaesthesia practice (n=54). Status quo of periprocedural anaesthesia management was evaluated on Concordance with existing national regulations regarding infrastructural requirements and status quo of periprocedural anaesthesia management. A nationwide survey of 54 German heart centres revealed broad variability in TF-TAVI anaesthesia management, with 75.9% of centres favouring monitored anaesthesia care over general anaesthesia.
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