SOLACI | Latin American Society of Interventional Cardiology

Courtesy of Dr. Carlos Fava.

Avoiding general anesthesia in intervention procedures has the benefits of faster recovery and shorter hospitalization. This has been already analyzed in the context of TAVR, but not in MitraClip procedures.

The present study analyzed 232 patients receiving the MitraClip. 76 of these procedures were done under general anesthesia (32.7%) and 156 under deep sedation (67.3%).

Populations were similar in age, comorbidities, EuroScore, severity of mitral failure, left and right ventricular function, and renal function.

Both strategies saw safe MitraClip implantation, with no difference in number of implanted clips, or residual mitral failure (with low complications rate). Only 2 patients required conversion to general anesthesia. Total procedural time was lower with deep sedation (DS), driven mainly by preparation.

Intensive care was shorter with DS (2.6±4.4 vs. 1.5±1.4 p=0.003). However, hospital stay was similar.

At 90 day follow up, both groups improved functional class and quality of life, saw reduced systolic pressure and BNP.

Conclusion

MitraClip implantation with DS is as safe and effective as with general anesthesia.

Commentary

Simplifying endovascular procedures with no quality compromise has always been beneficial.

Performing MitraClip procedures without general anesthesia reduced intensive care days, but with no difference in overall hospital stay. This might be because the researchers looked at patients between 2011 and 2015. After gaining experience and improving devices, this factor might improve as well.

To know the kind of patients that will benefit from this strategy calls for further research.

Courtesy of Dr. Carlos Fava.

Original Title: Deep Sedation Vs. Geneal Anesthesia in 232 patients undergoing Percutaneous Mitral Valve repair using the MitraClip® System.

Reference: Patrick Horn, et al Catheterization Cardiovascular Intervention 2017 Published online.