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

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Version 2 2024-06-03, 21:25
Version 1 2015-05-22, 11:00
journal contribution
posted on 2024-06-03, 21:25 authored by IJ Amat-Santos, E Dumont, J Villeneuve, D Doyle, M Rheault, D Lavigne, J Lemieux, A St-Pierre, Michael MokMichael Mok, M Urena, L Nombela-Franco, S Blackburn, M Simon, C Bourgault, JL Carrasco, P Pibarot, M Côté, R Delarochellière, DJ Cohen, J Rodés-Cabau
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.









London, Eng.

Open access

  • Yes








This article has a Correction - February 15, 2013

Publication classification

C Journal article, C1.1 Refereed article in a scholarly journal

Copyright notice

2012, BMJ Publishing Group Limited




BMJ Publishing Group