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.

中文翻译：

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严重慢性阻塞性肺疾病患者经导管主动脉瓣植入术的清醒镇静与全身麻醉

介绍：

慢性阻塞性肺疾病 (COPD) 被认为是经导管主动脉瓣植入术 (TAVI) 术后并发症的主要危险因素。迄今为止，对于这些患者的最佳麻醉管理尚无明确共识。我们旨在研究麻醉类型对接受 TAVI 的严重 COPD 患者临床结局的影响。

方法：

这是一项单中心回顾性研究，比较了 72 名接受 TAVI 治疗的严重 COPD 患者的清醒镇静 (CS) 与全身麻醉 (GA)。主要终点是 30 天全因死亡率和术后肺部并发症。

结果：

本研究感兴趣的主要结果是 GA 组的肺部并发症频率在统计学上更高（21.4% 对 3.3%，p = 0.038）。这些差异很可能归因于 GA，因为机械通气时间延长，ICU 停留时间延长（2 (1.2–3) vs 2.5 (2–4) 天，p = 0.029）与院内感染风险增加相关。两组之间的手术并发症和 30 天死亡率没有显着差异（GA；19% vs CS；13.3%，p = 0.521）。通过 Kaplan-Meier 分析比较，各组的一年生存率相似 (log-rank p = 0.733)。

结论：

在接受 TAVI 的严重 COPD 主动脉瓣狭窄患者中，与 CS 相比，使用 GA 与更高的呼吸相关并发症发生率和更长的 ICU 住院时间相关。CS 对这些患者来说是一种安全可行的选择，应被视为首选方法。