General anesthesia vs. sedation in transcatheter aortic valve implantation (TAVI): retrospective study of the incidence of acute kidney injury

Autores da FMUP

• Joana Irene De Barros Mourão

  Autor

Participantes de fora da FMUP

• Valente, MF
• Simoes, FJ

Unidades de investigação

• Cirurgia e Fisiologia

• Laboratório Associado RISE- Rede de Investigação em Saúde

  

  Investigador

  Fernando Carlos De Landér Schmitt

• RISE-Health

  

  Investigador

  Fernando Carlos De Landér Schmitt

Abstract

Introduction and objectives: Anesthetic techniques have been reported as having an impact on acute kidney injury (AKI) incidence in the postoperative period in patients undergoing transcatheter aortic valve implantation (TAVI). This study aimed to assess whether exists an association between anesthetic approach in patients undergoing TAVI and the post-operative AKI incidence. The existence of association between anesthetic approach and mortality was also assessed. Materials and methods: A retrospective, single-center, observational study was conducted at the Centro Hospitalar Universitario de sao Joao, a Portuguese reference center. All patients undergoing TAVI from January 2015 to June 2018 were recruited and were divided into two groups for analysis: general anesthesia (GA) and sedation. Results: One hundred and seven patients underwent TAVI (GA: n = 24; sedation: n = 83) and the overall incidence of AKI was 14.02%. We found a higher incidence of intraoperative hypotension in the GA group (83.3 vs. 33.7%, p < 0.001). Regarding postoperative outcomes, there were no significant differences in AKI incidence (20.8 vs. 12.0%, p = 0.319) and mortality. A significant association was found between postoperative AKI and preexisting chronic kidney disease (CKD), preoperative heart failure functional class, intraoperative hypotension, longer length of stay in level II unit, longer hospital stay and worsening of previous CKD stage. Conclusions: It was not possible to established association between the anesthetic approach for TAVI procedures and postoperative AKI and mortality. Our study reinforces the importance of preventing AKI incidence, considering its impact on the worsening of baseline CKD and on the length of stay, leading to higher hospitalization costs. (C) 2020 Sociedad Espanola de Anestesiologia, Reaninnacion y Terapeutica del Dolor. Published by Elsevier Espana, S.L.U. All rights reserved.

Keywords

• Transcatheter aortic valve implantation; General anesthesia; Sedation; Postoperative outcomes; Acute kidney injury; Mortality