EVALUATION OF THE FACTORS AFFECTING THE LENGTH OF STAY IN HOSPITAL OF TRANSCATHETER AORTIC VALVE IMPLANTATION (TAVI) CASES

EVALUATION OF THE FACTORS AFFECTING THE LENGTH OF STAY IN HOSPITAL OF TRANSCATHETER AORTIC VALVE IMPLANTATION (TAVI) CASES

Purpose: In the treatment of inoperable patients with severe aortic stenosis or at high surgical risk,transcatheter aortic valve implantation (TAVI) is applied as an alternative to surgical aortic valvereplacement. In our study, it was aimed to evaluate the factors affecting the length of stay in hospital ofTAVI cases.Method: After obtaining the approval of the ethics committee, the patients who received TAVI between09.06.2012-19.01.2018 in the Interventional Cardiology unit of Dokuz Eylül University were retrospectivelyscreened. A total of 243 patients were included in the study. Demographic data, preoperativeaccompanying diseases and echocardiographic results of the cases, the type of anesthesia applied, theduration of postoperative coronary intensive care and hospital stay of them were recorded. The analysisof the data was carried out in the SPSS 22.0 statistical package program, and the independent variablesand their relationship with discharge were tested with chi-square analysis.Results: 53.5% of the patients who underwent transcatheter aortic valve implantation received generalanesthesia, 46.5% received local anesthesia and sedation. 93.8% of the patients were discharged uponrecovery. There was no significant difference between patients' gender, age, mitral insufficiency level,aortic insufficiency level, tricuspid insufficiency level, aortic valve area, and preoperative comorbiddiseases and postoperative discharge time (p> 0.05). There was a significant difference between thepostoperative length of stay in hospital and the type of anesthesia (p=0.008). It was shown that patientsunderwent general anesthesia were discharged later than patients underwent sedation.Conclusion: Due to the high risks of surgery, it is of vital importance to shorten the length of stay inhospital in high-risk patients over 65 years of age who undergo TAVI.

___

  • 1. Bahar A., Parlar S, Yaşlılık ve Evde Bakım. Fırat sağlık Hizmetleri Dergisi, 2007; 2(4):32-39.
  • 2. E.R. Bates. Treatment options in severe aortic stenosis.Circulation, 124;2011:355-59.
  • 3. V.T. Nkomo, J.M.Gardin , T.N. Skelton, J.S. Gottdiener, C.G. Scott, Enriquez-Sarrono. Burden of valvular heart diseases:a population - based study. Lancet,368;2006:1005-11
  • 4. Vymazal T. Minimally invasive approach to calcified aortic valve replacement: Anaesthetic considerations. Indi Indian J Anaesth 2015;59:338–41.
  • 5. Covello RD, Ruggeri L, Landoni G, Guarracino F, Bignami E, Gonfalini M, et al. Transcatheter implantation of an aortic valve: anesthesiological management. Minerva Anestesiol 2010;76:100–8.
  • 6. Vahanian A, Alfieri O, Al-Attar N et al. Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European Association of Cardio-Thoracic Surgery (EACTS), the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2008;29:1463– 1470(crossref)
  • 7. Lung B, Baron G, Butchart EG, Delahaye F, Gohlke-Barwolf C, Levang OW, Tornos P, Vanoverschelde JL, Vermeer F, Boersma E, Ravaud P, Vahanian A (2003) A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on Valvular Heart Disease. Eur Heart J 24:1231–1243 (crossref)
  • 8. Lung B, Cachier A, Baron G et al Decisionmaking in elderly patients with severe aortic stenosis: why are so many denied surgery? Eur Heart J 2005;26:2714–2720(crossref)
  • 9. Conradi L, Seiffert M, Franzen O, Baldus S, Schirmer J, Meinertz T, Reichenspurner H, Treede H (2011) First experience with transcatheter aortic valve implantation, concomitant percutaneous coronary intervention. Clin Res Cardiol 100:311–316(crossref)
  • 10. Cribier A, Eltchaninoff H, Bash A et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case descrip- tion. Circulation 2002; 106: 3006-8. )
  • 11. Rex S. Anesthesia for transcatheter aortic valve implantation: an update. Curr Opin Anaesthesiol 2013;26:456–66. [CrossRef ]
  • 12. Petronio AS, Giannini C, De Carlo M, Bedogni F, Colombo A, Tamburino C, et al. Anaesthetic management of transcatheter aortic valve implantation: results from the Italian CoreValve registry. EuroIntervention 2016;12:381–8. [CrossRef ]
  • 13. Chou WH, Wang YC, Huang HH, Cheng HL, Lin YS, Wang MJ, et al. Transcatheter aortic valve implantation: Anesthetic experience of retrograde transfemoral approach with CoreValve ReValving System. Acta Anaesthesiol Taiwan 2014;52:2–5. [CrossRef ]
  • 14. Bonow RO, Leon MB, Doshi D, Moat N. Management strategies and futurechallenges for aortic valve disease. Lancet (London, England). 2016;387(10025):1312–23.2.
  • 15. Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, Tuzcu EM,Webb JG, Fontana GP, Makkar RR, et al. Transcatheter aorticvalveimplantation for aortic stenosis in patients who cannot undergo surgery. NEngl J Med. 2010;363(17):1597–607.
  • 16. He W., Goodkind D., Kowal P.: An aging world.2015. Washington, DC. January 3, 2019
  • 17. Wohlgemut J.M., Ramsay G., Jansen J.O.: The changing face of emergency general surgery.Ann Surg 2018
  • 18. Frohlich GM, Baxter PD, Malkin CJ, Scott DJ, Moat NE, Hildick-Smith D et al . Comparative survival after transapical, direct aortic, and subclavian transcatheter aortic valve implantation (data from the Uk TAVI registry). Am J Cardiol 2015; 116: 1555– 9.
  • 19. Contemporary review of severe aortic stenosis.Adams HSL, Ashokkumar S, Newcomb A, MacIsaac AI, Whitbourn RJ, Palmer S.Intern Med J. 2019 Mar;49(3):297-305. doi: 10.1111/imj.14071.PMID: 30091235 Review
  • 20. Erdost Aksu H, İyilikçi L, Duru SL et al. Experiences of transcatheter aortic valve ımplantation with sevre aortic stenosis. Haydarpasa Numune Med J 2020;60(29173-77.
  • 21. Agarwal, A. Rajamanickam, N.S. Bajaj, et al.Impact of aortic stenosis on postoperative outcomes after noncardiac surgeries.Circ Cardiovasc Qual Outcomes, 6 (2013), pp. 193- 200
  • 22. Tashiro, S.V. Pislaru, J.M. Blustin, et al.Perioperative risk of major non-cardiac surgery in patients with severe aortic stenosis: a reappraisal in contemporary practiceEur Heart J, 35 (2014), pp. 2372-2381
  • 23. Mallikethi-Reddy S,Akitonye E,Telila T et al. transcaatheter aortic valve implantation in the United States: Predictors of early hospital discharge.J Interven Cardiol.2017;30;149-55.
  • 24. Barbanti M, Capranzano P, Ohno Y, et al. Early discharge after transfemoral transcatheter aortic valve implantation. Heart. 2015;101:1485–1490.
  • 25. Durand E, Eltchaninoff H, Canville A, et al. Feasibility and safety of early discharge after transfemoral transcatheter aortic valve implantation with the Edwards SAPIEN-XT prosthesis. Am J Cardiol. 2015;115:1116–1122.
  • 26. Ruggeri L, Gerli C, Franco A, Barile L, Magnano di San Lio MS, Villari N, et al. Anesthetic management for percutaneous aortic valve implantation: an overview of worldwide experiences. HSR Proc Intensive Care Cardiovasc Anesth 2012;4:40–6.
  • 27. Shaw E,Gornila A,Piriz M et al.Multistate modelling to estimate excess length of stay and risk of death associated with organ/space infection after elective colorectal surgery. Journal of Hospital Infection.2018;100(4):400-05.
  • 28. Pardo PL,Garcia S,Cortes JJB. Influence of the length of hospital stay mortality after discharge in older patients with acute medical diseases. Gac Sanit. 2016;30(5):375-8. Motloch LJ, Rottlaender D, Reda S. Et all. Local versus general anesthesia for transfemoral aortic valve implantation Clinical Research in Cardiology.2012;101:45-53.
  • 29. Dehedin B, Guinot PG, Ibrahim H et al.Aneshesia and perioperative management of patients who undergo transfemoral transcatheter aortic valve implantation: an observational study of general versuslocal/regional anesthesia in 125 consecutive patients. J Cardiothroc Vasc Anesth. 2011;(6):1036-43.
  • 30. Franco A, Gerli C, Ruggeri L, Monaco F. Anesthetic management of transcatheter aortic valve implantation. Annals of Cardiac Anaesthesia 2012;15:54-63.
  • 31. O’Connor ED, Walsham J (2009) Should we mobilise critically ill patients? A review. Crit Care Resusc 2009;11:290–300
  • 32. Melidi E, Latsios G, Toutouzas K, Vavouranaki M, Tolios I, Gouliami M, et al. Cardio-anesthesiology considerations for the transcatheter aortic valve implantation (TAVI) procedure. Hellenic Society of Cardiyology 2016;57:401-6