Local Anesthesia for Surgical Repair of TF - TAVI Access - Site Lesions

Gabor Gäbel, Thomas I Kiss, Eike Speck, Vera von Dossow, Jens Werner, Julinda Mehilli, Steffen Massberg, Miriam Holdt and Frank Schönleben

Department of General, Visceral, Transplant and Vascular Surgery, Ludwig Maximilian University Munich, Germany
Department of Vascular Surgery, Helios Klinikum Krefeld, Krefeld, Germany
Department of Anesthesiology, Technical University Carl - Gustav - Carus, Dresden, Germany
Department of Anesthesiology, Ludwig Maximilian University Munich, Munich, Germany
Department of Cardiology, Ludwig Maximilian University Munich, Munich, Germany
Institute of Laboratory Medicine, Ludwig Maximilian University Munich, Munich, Germany
Department of Vascular Surgery, University Hospital Würzburg, Würzburg, German

^*Correspondance to: Gabor Gabel 

 PDF  Full Text DOI: 10.25107/2474-1647.1999

Abstract

Aim: We evaluated the impact of the anesthesiologic approach on the outcome of patients in need of surgical repair of the access - site after transfemoral transcatheter aortic valve implantation (TFTAVI).Methods and
Results: In this retrospective study we included 26 patients, who required surgical repair for femoral access-site complications after TF-TAVI. This collective was divided into two groups: First group, where surgical repair was performed under general anesthesia (GA, n=11), and a second group receiving surgery in local anesthesia and conscious sedation (LAS, n=15). The groups were analysed regarding complications and mortality. There were no significant differences for patient characteristics between the two groups. GA patients received significant more vasopressors and were in higher need for transfusion of blood products. As a result they spent significant longer time on intensive care units (192.7 ± 150.9 vs. 35.0 ± 41.2 hrs; P=0.0012). One-year mortality was significantly higher in the GA group (54.5% vs. 7.7%; P=0.0233). The Kaplan Meier analysis of survival also revealed a significant benefit for LAS (P=0.0052).Conclusion: Repair of femoral access-site complications after TF-TAVI in LAS appears the superior alternative to GA, since it has less effect on the haemodynamic stability of these fragile patients. We were able to demonstrate that this approach is associated with significant improved survival.

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Cite the article

Gabel G, Kiss TI, Speck E, von Dossow V, Werner J, Mehilli J, et al. Local Anesthesia for Surgical Repair of TF - TAVI Access - Site Lesions. Clin Surg. 2018; 3: 1999.