Key result
Fast-track anesthesia using paravertebral blockade in 6 high-risk patients undergoing transapical valve implantation resulted in 0% operative mortality and a mean intensive-care stay of 13.8 hours.
Why the study?
Patients undergoing transapical transcatheter aortic/mitral valve implantation face higher risks of morbidity, mortality, and prolonged hospital stays, which fast-track anesthesia might reduce.
Does fast-track anesthesia using paravertebral block and double-lumen laryngeal mask reduce perioperative complications and admission stays in high-risk patients undergoing transapical transcatheter valve implantation?
Observational (n=6)
No
Does fast-track anesthesia using paravertebral block and double-lumen laryngeal mask reduce perioperative complications and admission stays in high-risk patients undergoing transapical transcatheter valve implantation?
Fast-track anesthesia using paravertebral blockade and a double-lumen laryngeal mask is a feasible and potentially safe alternative to conventional general anesthesia for high-risk patients undergoing transapical transcatheter valve replacement.
May support shorter ICU stays after transapical TAVI; leaves open efficacy versus standard care in prospective trials.
BACKGROUND: Patients who undergo transapical transcatheter aortic/mitral valve implantation are at higher risk of morbidity and mortality than those undergoing transvascular procedures. In addition, these patients have prolonged intensive care and hospital courses. Fast-track anesthesia could reduce perioperative complications and admission stays in such patients. METHODS: This retrospective single-center study, evaluates six high-risk patients undergoing transapical valve implantation between 01/2020 till 01/2021. All patients received a paravertebral block (PVB) as part of a fast-track approach. The airway was secured with a Gastro-double-lumen laryngeal mask which includes one orifice was for ventilation and one for the transesophageal echocardiography probe. Anesthesia was maintained with a volatile anesthetic (Sevoflurane MAC 1%). Immediately post procedure, all patients were awakened and admitted to the intermediate/intensive-care unit. RESULTS: Three patients were females, mean age =71±6 years, patients' risk profiles were high (mean Log. EuroSCORE-I 22% & STS-PROM 10%). No incidents of re-intubation, atelectasis/pneumonia, low output syndrome, stroke, dialysis, pacemaker implantation or operative mortality were reported. One patient (16.7%) underwent re-exploration for bleeding and developed a wound infection. Postoperative pain scores showed that no patient required additional analgesics after the initial eight hours post procedure. Mean postoperative intermediate/intensive-care stay was 13.8±3.2 hours and patients were mobilized early and discharged to the normal ward. CONCLUSIONS: Fast-track anesthesia using paravertebral-blockade for transcatheter transapical valve replacement in high-risk patients is a possible anesthetic approach. An effective PVB, in addition to a double-lumen laryngeal mask, provide an alternative strategy to conventional general anesthesia. These promising results could encourage further consideration of this approach in similar cardiac surgery patients.
No takes yet. Share an insight, caveat, or question.
Haddad et al. (2021) conducted an observational in Transapical transcatheter aortic/mitral valve implantation (n=6). Fast-track anesthesia (paravertebral block and double-lumen laryngeal mask) was evaluated on Perioperative complications and admission stays. Fast-track anesthesia using paravertebral blockade in 6 high-risk patients undergoing transapical valve implantation resulted in 0% operative mortality and a mean intensive-care stay of 13.8 hours.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: