Key result
Conscious sedation for TAVI in severe COPD is linked to ~85% fewer pulmonary complications versus general anesthesia.
Why the study?
There is no clear consensus on the optimal anesthesia management for patients with severe COPD undergoing TAVI, a group at major risk for postoperative complications.
Does conscious sedation reduce postoperative pulmonary complications and mortality compared to general anesthesia in patients with severe COPD undergoing TAVI?
Cohort (n=72)
No
Does conscious sedation reduce postoperative pulmonary complications and mortality compared to general anesthesia in patients with severe COPD undergoing TAVI?
Conscious sedation is a safe and viable option for TAVI in patients with severe COPD, associated with fewer pulmonary complications and shorter ICU stays compared to general anesthesia.
Conscious sedation may lower pulmonary complications in severe COPD TAVI; leaves open need for randomized confirmation before practice change.
INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is considered a major risk factor for postoperative complications after transcatheter aortic valve implantation (TAVI). To date, there is no clear consensus on the best anesthesia management for these patients. We aimed to investigate the effects of types of anesthesia on clinical outcomes in patients with severe COPD undergoing TAVI. METHODS: This is a single-center, retrospective study comparing conscious sedation (CS) versus general anesthesia (GA) in 72 patients with severe COPD who underwent TAVI. The primary endpoints were 30-day all-cause mortality and postoperative pulmonary complications. RESULTS: The main outcome of interest of this study was that the frequency of pulmonary complications was statistically higher in the GA group (21.4% vs 3.3%, p = 0.038). These differences are most likely attributed to the GA because of prolonged mechanical ventilation, and longer ICU stay (2 (1.2-3) vs 2.5 (2-4) days, p = 0.029) associated with an increased risk of nosocomial infections. There were no significant differences in procedure complications and 30-day mortality between the two groups (GA; 19% vs CS; 13.3%, p = 0.521). One-year survival rates, compared by Kaplan-Meier analysis, were similar between groups (log-rank p = 0.733). CONCLUSION: In aortic stenosis patients with severe COPD undergoing TAVI, the use of GA compared with CS was associated with higher incidences of respiratory-related complications, and longer ICU length of stay. CS is a safe and viable option for these patients and should be considered the favored approach.
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Aslan et al. (2021) conducted a cohort in Severe chronic obstructive pulmonary disease (COPD) undergoing TAVI (n=72). Conscious sedation vs. General anesthesia was evaluated on Postoperative pulmonary complications (p=0.038). Conscious sedation compared with general anesthesia in severe COPD patients undergoing TAVI was associated with a lower rate of postoperative pulmonary complications (3.3% vs 21.4%, p=0.038).
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