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Thoracic epidural analgesia may offer better analgesia, reduce complications after transapical TAVR
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Thoracic epidural analgesia provided superior analgesia following transapical transcatheter aortic valve replacement and was associated with fewer periprocedural respiratory complications, and less short- and long-term mortality, according to study results.
To determine the impact of perioperative thoracic epidural analgesia (TEA) on acute and late outcomes following transapical (TA)-TAVR, researchers enrolled 135 consecutive patients who underwent TA-TAVR, 74 of whom underwent TEA and 61 of whom underwent intercostal local analgesia with a catheter placed at the surgical incision site.
Maximal postoperative pain was higher in the non-TEA group (4; interquartile range [IQR], 3-5) compared with the TEA group (2; IQR, 1-3; P<.001).
There was a higher rate of pulmonary complications in the non-TEA group (P<.05 for nosocomial pneumonia, reintubation and tracheostomy) compared with patients who underwent TEA.
Non-TEA patients had a higher 30-day in-hospital mortality rate than the TEA group (22.9% vs. 2.7%; P<.001).
Mortality remained higher 1 year postoperatively in the non-TEA group (31.1%) compared with the TEA group (10.8%; P=.005).
A propensity score-matched analysis that included 100 matched patients showed that predictors of increased cumulative late mortality included Society of Thoracic Surgeons predicted risk of mortality score (P=.027) and not undergoing TEA (P=.039).
Researchers noted that pulmonary complications were the cause of death in about half of the patients who died postoperatively, and that all fatal pulmonary complications occurred in patients who did not undergo TEA.
"This, in turn, translated into a risk of perioperative mortality that was approximately nine times greater among those patients not receiving TEA (approximately six times greater after propensity matching), strongly suggesting an important role for TEA in reducing pulmonary complications and improving clinical outcomes (including survival) following TA-TAVR."
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