心血管疾病与诊断

Predictors of Successful Fast Track Protocol in Transfemoral Transcatheter Aortic Valve Implantation Under General Anaesthesia

Abstract

Tamer Owais, Iliazbek Kazakbaev, Mohammad El Garhy, Norbert Salewsky, Lars Hüter, Torsten Schreiber, Waheedullah Karzai and Thomas Kuntze

Objectives: There is no consensus about the optimal length of hospital stay in patients undergoing elective transfemoral TAVR under general anesthesia. Our study tried to find predictors of failure of early discharge strategy in those patients.

Methods and results: We included retrospectively 135 high risk TAVI patients (mean Log. EuroSCORE 30.8 ± 6) operated under general anaesthesia between June 2017 and January 2018 in central hospital, Bad Berka, Germany. Focus on the preoperative factors was established in favor to find possible predictors of longer hospital stay in this group of patients. Uni- and multivariate analysis were performed to identify independent preoperative predictors of fast-track protocol failure, defined as inability to discharge the patient from the hospital five days after surgery. Independent predictors of fast-track protocol failure were NYHA IV (OR 4.3; CI 95% 2.3-25, p-Value 0.017), ejection fraction (EF) ≤ 30% (OR 3.5; CI 95% 2-12.5, p-Value 0.006), right bundle branch block (OR 4.7; CI 95% 1.25-25, p-Value 0.03) and stroke with residual disability (OR 4.5; CI 95% 1.1-16, p-Value 0.025).

Conclusion: NYHA IV, severely reduced ejection fraction, right bundle branch block and stroke with residual disability might be considered potential predictors of failure of fast track protocol in patient undergoing TAVI under general anesthesia.