Evaluation of Anaesthetic Approaches in Transcatheter Aortic Valv Implantation Procedures

Objective:Transcatheter aortic valve implantation (TAVI) has emerged as an alternative to surgical aortic valve replacement and has become a popular treatment modality for inoperable or patients at high surgical risk with severe aortic stenosis. We aimed to evaluate our perioperative anaesthetic experiences with patients undergoing TAVI under sedation or general anaesthesia (GA).Methods:One hundred and fifty-nine patients who underwent TAVI procedures were enrolled. Effects on TAVI outcomes of sedation and GA were compared.Results:The duration of surgery and anaesthesia was significantly longer in patients who received GA. Insertion site complication and post-TAVI pacemaker implantation rates were similar between the groups, but the frequency of intraoperative complications (10% vs. 0.8%; P=0.015), intraoperative hypotension (35.3% vs. 70%; P < 0.001), and acute kidney injury (12.6% vs. 27.5%; P=0.028) was significantly higher in the GA group. Stroke occurred in seven patients, and all were in the sedation group.Conclusion:GA is related to increased procedure time and acute kidney injury; therefore, local anaesthesia and sedation may be the first option in patients undergoing TAVI

MİTRAL ANULER KALSİFİKASYONUN TRANSKATETER AORTİK VALV İMPLANTASYONU SONLANIMLARI ÜZERİNE ETKİLERİNİN DEĞERLENDİRİLMESİ

ŞENER YZ. Evaluating The Effects of Mitral Annular Calcification on The Outcomes of Transcatheter Aortic Valve Implantation, Hacettepe University Faculty of Medicine, Cardiology Thesis. Ankara, 2020. Transcatheter aortic valve implantation (TAVI) has become the standard of care treatment in patients with severe aortic stenosis who carry intermediate or high risk for surgical aortic valve replacement. Mitral annular calcification (MAC) is frequently seen in patients with aortic stenosis and it is associated with increased cardiovascular morbidity and mortality. It is reported that MAC is an independent predictor of all cause mortality after TAVI. The aim of this study is to both evaluate the relationship between mitral annular calcification and TAVI related complications and mortality; and to define the predictors of both all cause mortality and permanent pacemaker implantation after TAVI. All of the patients who underwent TAVI procedure due to severe aortic stenosis between 01.01.2020 and 01.06.2020 in Hacettepe University Hospital were screened and patients fullfilling including criterias were enrolled. Patients’ baseline demographic datas, laboratory, echocardiography and TAVİ procedure related parameters were recorded. Outcomes are identified as follows; association between mitral annular calcification and TAVI related complications, establishment of the predictors of all cause mortality and permanent pacemaker implantation, definition of the in-hospital and all cause mortality rates. A total of 245 patients including 98 males (40 %) and 147 females (60 %) were enrolled in the study. The mean age of the population was 76,3 ± 8,3 years. The mean left ventricular ejection fraction was % 54,8 ± 11,4; aortic valve area was 0,74 ± 0,14 cm2 and mean aortic transvalvular gradient was 47,0 ± 14,3 mmHg. MAC was detected in 148 (% 60,4) patients. In-hospital mortality was occured in 14 (5,7 %) cases. Permanent pacemaker implantation was performed in %17,8 (n=42) patients and all cause mortality was developed in 89 (36,3 %) cases during the median 23,1 (11,6-44,3) months follow-up. Pericardial effusion (26,4% vs 12,4%; p=0,013) and contrast induced nephropathy (21,6% vs 7,2%; p=0,005) were developed more frequently in patients with MAC than without MAC. Only the presence of MAC extending to left ventricular outflow tract was detected to be independent predictor of permanent pacemaker implantation requirement (HR:3,32; p=0,002). All cause mortality predictors were established as; use of renin-angiotensin-aldosterone system blockers (HR: ; p=0,012), level of hemoglobin (HR:0,79; p=0,006), severe mitral annular calcification (HR:1,94; p=0,024) and atrial fibrillation development after TAVI (HR:2,39; p=0,002). There was not any correlation between aortic valve area and MAC vloume (r=0,03; p=0,689), MAC Hounsfield Unit (r= -0,007; p=0,934) and MAC Agatston score (r= -0,08; p=0,290).ŞENER YZ. Mitral Anuler Kalsifikasyonun Transkateter Aortik Valv İmplantasyonu Sonlanımları Üzerine Etkilerinin Değerlendirilmesi, Hacettepe Üniversitesi Tıp Fakültesi, Kardiyoloji Tezi. Ankara, 2020. Ciddi aort stenozu olan orta ve yüksek cerrahi riskli hastalarda transkateter aortik valv implantasyonu (TAVİ) standart tedavi haline gelmiştir. Mitral anuler kalsifikasyon (MAK); ciddi aort darlığı olan hastalarda sık görülür ve artmış kardiyovasküler morbidite ve mortalite ile ilişkilidir. Mitral anuler kalsifikasyonun TAVİ sonrası takipte tüm nedenlere bağlı mortalitenin bağımsız bir prediktörü olduğu gösterilmiştir. Bu çalışmanın amacı; ciddi aort darlığı olan hastalarda mitral anuler kalsifikasyonun TAVİ sonrası komplikasyonlarla ve mortalite ile ilişkisinin değerlendirilmesi; TAVİ sonrası mortalite ve kalıcı kalp pili ihtiyacının prediktörlerinin belirlenmesidir. Çalışmaya 01.01.2010 - 01.06.2020 tarihleri arasında Hacettepe Üniversitesi Tıp Fakültesi Hastanesi’nde ciddi aort darlığı nedeni ile TAVİ yapılan hastalar tarandıktan sonra dahil edilme kriterlerini karşılayan hastalar çalışmaya alındı. Hastaların bazal demografik verileri, laboratuvar ve ekokardiyografik parametreleri, TAVİ işlemine ait verileri kaydedildi. Çalışmanın sonlanım noktaları olarak mitral anuler kalsifikasyonun TAVİ sonrası komplikasyonlarla ilişkisi, TAVİ sonrası kalıcı kalp pili ihtiyacı prediktörlerinin tespit edilmesi, hastane içi ve tüm nedenlere bağlı mortalite oranlarının saptanması ve mortalite ilişkili faktörlerin tespit edilmesi olarak belirlendi. Araştırmaya 98 erkek (%40) ve 147 (% 60) kadın olmak üzere 245 hasta dahil edildi. Hastaların ortalama yaşı 76,3 ± 8,3 yıl idi. Hastaların ortalama sol ventrikül ejeksiyon fraksiyonu (EF) % 54,8 ± 11,4; aortik kapak alanı 0,74 ± 0,14 cm2; ve ortalama aortik transvalvuler gradyenti 47,0 ± 14,3 mmHg olarak tespit edildi. 148 (% 60,4) hastada MAK tespit edildi. Hastane içi mortalite 14 (%5,7) hastada gelişti. Ortanca 23,1 (11,6-44,3) aylık takip süresinde hastaların %17,8’ine (n=42) kalıcı kalp pili implantasyonu yapıldı ve tüm nedenlere bağlı mortalite 89 (%36,3) hastada gelişti. MAK olan olgularda; perikardiyal efüzyon (%26,4’e karşı %12,4; p=0,013) ve kontrast nefropatisinin (%21,6’ya karşı %7,2; p=0,005) MAK olmayan hastalara göre daha fazla olduğu tespit edildi. Kalp pili itiyacının prediktörü olarak sadece sol ventrikül çıkış yoluna uzanım gösteren MAK varlığı (HR:3,32; p=0,002) saptandı. RAAS blokörü kullanımı (HR: ; p=0,012), hemoglobin düzeyi (HR:0,79; p=0,006), TAVİ sonrası atriyal fibrilasyon gelişimi (HR:2,39; p=0,002) ve mitral anuler kalsifikasyonun ciddi olması (HR:1,94; p=0,024) tüm nedenlere bağlı mortalitenin öngördürücüleri olarak tespit edildi. Aortik kapak alanı ile MAK volümü (r=0,03; p=0,689), MAK Hounsfield ünitesi (r= -0,007; p=0,934) ve MAK Agatston skoru (r= -0,08; p=0,290) arasında korelasyon saptanmadı

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