Bispectral index-guided sedation in transfemoral transcatheter aortic valve implantation: a retrospective control study
Transcatheter aortic valve implantation (TAVI) is a minimally invasive therapy for elderly patients with severe aortic valve stenosis who were refused surgical aortic valve replacement because of the high perioperative risk. Traditionally, this procedure has been done under general anesthesia, but more recently local anesthesia and sedation have become popular. This research assessed the effectiveness of transfemoral TAVI under bispectral index (BIS)-guided sedation. In this single-center retrospective control analysis, clinical data, including demographic characteristics, echocardiography, periprocedural data, and main complications, were collected and assessed in 113 patients undergoing TAVI through the femoral artery under general anesthesia (GA group, n=36) and under BIS-guided sedation (SED group, n=77). The demographic characteristics and echocardiographic parameters between the two groups were similar (P>0.05). Two (2.6%) of patients were moved from BIS-guided sedation to general anesthesia for surgical reasons. Procedures were significantly shorter in the SED group than in the GA group ((127.10±44.43) min vs. (165.90±71.62) min, P=0.004). Patients in the SED group lost less blood and received significantly fewer red blood cells and catecholamines than those in the GA group (5.19% vs. 22.22%, P=0.017 and 67.53% vs. 97.22%, P<0.001). The length of hospital stay was significantly shorter and there were fewer pulmonary complications in the SED group than in the GA group. Thirty-day mortality was similar between the two groups. BIS-guided sedation is a feasible and safe approach for transfemoral TAVI. The anesthesiologist should choose the best anesthetic method according to the team’s experience. 脑电双频谱指数导向的镇静在股动脉入路经导管主动脉瓣植入术中的应用 探讨脑电双频谱指数(BIS)导向的镇静在股动 脉入路经导管主动脉瓣植入术(TAVI)中的可行 性和有效性。 由于TAVI 患者高龄、心功能差、合并症多,加 上导管室布局不利于麻醉操作,实施镇静难度很 大。我们利用目前常用的镇静监测手段BIS 来实 施导向镇静,有效地实现了深度可控的镇静,减 少了并发症。 回顾了本中心所有经股动脉入路的113 名TAVI 患者(图1)。将患者分为两组,其中36 名患者 进行了全身麻醉,77 名患者施行了BIS 导向的镇 静。两组患者的术前一般情况的差别不显著 (表1)。术中资料显示,BIS 导向的镇静组较全身 麻醉组手术时间更短、失血更少、输血制品和血 管活性药使用更少(表2)。术后的资料显示,两 组的30 天死亡率差异不显著,而BIS 导向的镇静 组有更短的住院时间和更少的肺部并发症(表3)。 BIS 导向的镇静在股动脉入路TAVI 是安全可行 的。各个临床中心可根据自身经验选择最合适的 麻醉方法。