Key result
General anesthesia during TAVR did not significantly affect the 1-year primary composite endpoint compared to conscious sedation (51.5% vs 41.2%; P=0.182), but increased new-onset AF and AKI.
Why the study?
The study was conducted to examine the key impacts of anesthesia on new-onset AF and AKI in patients undergoing TAVR.
Does general anesthesia increase the risk of adverse outcomes compared to conscious sedation in patients undergoing TAVR?
Cohort (n=173)
No
Does general anesthesia increase the risk of adverse outcomes compared to conscious sedation in patients undergoing TAVR?
Absolute Event Rate: 51.5% vs 41.2%
p-value: p=0.182
In patients undergoing TAVR, general anesthesia is associated with an increased risk of new-onset atrial fibrillation and acute kidney injury compared to conscious sedation, supporting the broader use of conscious sedation.
GA associated with higher post-TAVR AF and AKI risk; leaves open whether anesthesia choice affects outcomes in prospective trials.
PURPOSE: To examine key impacts of anesthesia on new-onset atrial fibrillation (AF) and acute kidney injury (AKI) in transcatheter aortic valve replacement (TAVR). METHODS: All consecutive patients who underwent transfemoral, transapical, and transaortic TAVR in Fuwai Hospital from 2012 to 2018 were retrospectively analyzed and dichotomized into 2 groups: TAVR under conscious sedation (CS) and under general anesthesia (GA). The primary endpoint was a composite of all-cause mortality, stroke, AF, permanent pacemaker implantation, myocardial infarction, heart failure, high-grade atrioventricular block, and AKI at 1 year. Binary logistic regression and adjusted multilevel logistic regression were performed to analyze the predictors of AF and AKI. RESULTS: A total of 107 patients were under CS and 66 patients under GA. No significant difference was observed in the composite endpoint (51.5% vs. 41.2%, GA vs. CS, P = .182) and ≥ mild paravalvular leakage (36.4% vs. 31.4%, GA vs. CS, P = .589) at 1 year. However, the GA group had a significantly higher rate of intensive care unit (ICU) admission (84.8% vs. 6.5%, P < .001), AKI (28.8% vs. 14.0%, P = .018), new-onset AF (15.2% vs. 5.5% at 1 year, P = .036). Multivariable analysis revealed GA to be the significant predictor of new-onset AF (odds ratio 3.237, 95% confidence interval 1.059 to 9.894, P = .039) and AKI (odds ratio 2.517, 95% confidence interval 1.013 to 6.250, P = .047). CONCLUSION: GA was associated with higher rates of ICU admission, postoperative AKI, and new-onset AF. The results may provide new evidence that CS challenges universal GA.
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Liang et al. (2021) conducted a cohort in Transcatheter aortic valve replacement (TAVR) (n=173). General anesthesia vs. Conscious sedation was evaluated on Composite of all-cause mortality, stroke, AF, permanent pacemaker implantation, myocardial infarction, heart failure, high-grade atrioventricular block, and AKI at 1 year (p=0.182). General anesthesia during TAVR did not significantly affect the 1-year primary composite endpoint compared to conscious sedation (51.5% vs 41.2%; P=0.182), but increased new-onset AF and AKI.