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

Amat-Santos, Ignacio J., Dumont, Eric, Villeneuve, Jacques, Doyle, Daniel, Rheault, Michel, Lavigne, Dominique, Lemieux, Jerome, St-Pierre, Andre´, Mok, Michael, Urena, Marina, Nombela-Franco, Luis, Blackburn, Steve, Simon, Mathieu, Bourgault, Christine, Carrasco, Jose´ Luis, Pibarot, Philippe, Côté, Melanie, Delarochellière, Robert, Cohen, David J. and Rodés-Cabau, Josep 2012, Effect of thoracic epidural analgesia on clinical outcomes following transapical transcatheter aortic valve implantation, Heart, vol. 98, no. 21, pp. 1583-1590, doi: 10.1136/heartjnl-2012-302185.

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Title Effect of thoracic epidural analgesia on clinical outcomes following transapical transcatheter aortic valve implantation
Author(s) Amat-Santos, Ignacio J.
Dumont, Eric
Villeneuve, Jacques
Doyle, Daniel
Rheault, Michel
Lavigne, Dominique
Lemieux, Jerome
St-Pierre, Andre´
Mok, MichaelORCID iD for Mok, Michael orcid.org/0000-0003-1839-2316
Urena, Marina
Nombela-Franco, Luis
Blackburn, Steve
Simon, Mathieu
Bourgault, Christine
Carrasco, Jose´ Luis
Pibarot, Philippe
Côté, Melanie
Delarochellière, Robert
Cohen, David J.
Rodés-Cabau, Josep
Journal name Heart
Volume number 98
Issue number 21
Start page 1583
End page 1590
Total pages 8
Publisher BMJ Publishing Group
Place of publication London, Eng.
Publication date 2012-11
ISSN 1355-6037
Keyword(s) Aged
Aged, 80 and over
Analgesia, Epidural
Aortic Valve Stenosis
Cardiac Catheterization
Follow-Up Studies
Heart Valve Prosthesis Implantation
Hospital Mortality
Risk Factors
Survival Rate
Treatment Outcome
Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
Summary 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.
Notes This article has a Correction - February 15, 2013 http://dx.doi.org/10.1136/heartjnl-2012-302185corr1
Language eng
DOI 10.1136/heartjnl-2012-302185
Field of Research 110201 Cardiology (incl Cardiovascular Diseases)
1102 Cardiovascular Medicine And Haematology
Socio Economic Objective 920103 Cardiovascular System and Diseases
HERDC Research category C1.1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2012, BMJ Publishing Group Limited
Persistent URL http://hdl.handle.net/10536/DRO/DU:30073391

Document type: Journal Article
Collections: Faculty of Health
School of Medicine
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