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コヤナギ チヒロ
Koyanagi Chihiro
小栁 千紘 所属 医学部 医学科（東京女子医科大学病院） 職種 助教 |
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| 論文種別 | 原著 |
| 言語種別 | 英語 |
| 査読の有無 | 査読あり |
| 表題 | Minimum-incision trans-subclavian transcatheter aortic valve replacement with regional anesthesia. |
| 掲載誌名 | 正式名：Journal of cardiology 略 称：J Cardiol ISSNコード：18764738/09145087 |
| 掲載区分 | 国外 |
| 巻・号・頁 | 81(2),pp.131-137 |
| 著者・共著者 | Domoto Satoru†, Nakazawa Keisuke, Yamaguchi Junichi, Hayakawa Minako, Otsuki Hisao, Inagaki Yusuke, Saito Chihiro, Arashi Hiroyuki, Kogure Tomohito, Niinami Hiroshi |
| 発行年月 | 2023/02 |
| 概要 | BACKGROUND:Minimum-incision trans-subclavian transcatheter aortic valve replacement (MITS-TAVR) is usually performed in patients who are contraindicated for transfemoral TAVR, under regional anesthesia (RA). This study aimed to evaluate the safety and efficacy of MITS-TAVR under RA compared to MITS-TAVR under general anesthesia (GA).METHODS:This single-center observational study included 44 consecutive patients who underwent MITS-TAVR under RA (RA group, n = 19) and GA (GA group, n = 25). RA was achieved using an ultrasound-guided nerve block.RESULTS:The rates of respiratory disease (RA vs. GA, 36.8 % vs. 4.0 %; p < 0.01) and dialysis (79.0 % vs. 0 %; p < 0.01) were significantly higher in the RA group. STS score was significantly higher in the RA group (RA vs. GA, 10.8 ± 1.06 % vs. 7.87 ± 0.93 %; p < 0.01). Both groups had a 100 % procedural success rate. The two groups showed comparable operation room stay times (RA vs. GA, 160 ± 6.96 min vs. 148 ± 5.90 min; p = 0.058). The mean rate of change in blood pressure, used as an index of hemodynamic stability, was significantly lower in the RA group (RA vs. GA, 19.0 ± 3.4 % vs. 35.5 ± 3.0 %; p < 0.01). No in-hospital deaths occurred in either group. One case of minor dissection occurred in the GA group (RA vs.GA, 0 % vs. 4.0 %, p = 0.378). The intensive care unit stay (RA vs. GA, 0.21 ± 0.11 days vs. 1.24 ± 0.10 days; p < 0.01) and hospital stay (RA vs. GA, 7.00 ± 1.73 days vs. 12.2 ± 1.44 days; p < 0.01) were significantly shorter in the RA group.CONCLUSIONS:MITS-TAVR under RA is safe and effective and might be a promising alternative approach. It could ensure intraoperative hemodynamic stability and shorten intensive care unit and hospital stays. |
| DOI | 10.1016/j.jjcc.2022.07.006 |
| PMID | 35882612 |