You are not logged in.

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.

Attached Files
Name Description MIMEType Size Downloads

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, Michael
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
1468-201X
Keyword(s) Aged
Aged, 80 and over
Analgesia, Epidural
Aortic Valve Stenosis
Cardiac Catheterization
Female
Follow-Up Studies
Heart Valve Prosthesis Implantation
Hospital Mortality
Humans
Male
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
Collection: School of Medicine
Connect to link resolver
 
Unless expressly stated otherwise, the copyright for items in DRO is owned by the author, with all rights reserved.

Versions
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 14 times in TR Web of Science
Scopus Citation Count Cited 23 times in Scopus
Google Scholar Search Google Scholar
Access Statistics: 5 Abstract Views, 2 File Downloads  -  Detailed Statistics
Created: Fri, 13 Nov 2015, 11:32:04 EST

Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.