William Hickman, Rachel S Dada, Dylan Thibault, Christina Gibson, Scott Heller, Vikrant Jagadeesan, Heather K Hayanga
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Traditionally, general anesthesia (GA) has been more commonly used primarily due to the necessity of transesophageal echocardiography.</p><p><strong>Aims: </strong>Compare trends of monitored anesthesia care (MAC) versus GA for percutaneous transcatheter LAAC with endocardial implant and assess for independent variables associated with primary anesthetic choice.</p><p><strong>Settings and design: </strong>Multi-institutional data collected from across the United States using the National Anesthesia Clinical Outcomes Registry.</p><p><strong>Material and methods: </strong>Retrospective data analysis from 2017-2021.</p><p><strong>Statistical analysis used: </strong>Independent-sample t tests or Mann-Whitney U tests were used for continuous variables and Chi-square tests or Fisher's exact test for categorical variables. Multivariate logistic regression was used to assess patient and hospital characteristics.</p><p><strong>Results: </strong>A total of 19,395 patients underwent the procedure, and 352 patients (1.8%) received MAC. MAC usage trended upward from 2017-2021 (P < 0.0001). MAC patients were more likely to have an American Society of Anesthesiologists (ASA) physical status of≥ 4 (33.6% vs 22.89%) and to have been treated at centers in the South (67.7% vs 44.2%), in rural locations (71% vs 39.5%), and with lower median annual percutaneous transcatheter LAAC volume (102 vs 153 procedures) (all P < 0.0001). In multivariate analysis, patients treated in the West had 85% lower odds of receiving MAC compared to those in the Northeast (AOR: 0.15; 95% CI 0.03-0.80, P = 0.0261).</p><p><strong>Conclusions: </strong>While GA is the most common anesthetic technique for percutaneous transcatheter closure of the left atrial appendage, a small, statistically significant increase in MAC occurred from 2017-2021. 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引用次数: 0
摘要
背景：左心房阑尾闭合术（LAAC）是作为一种新的预防中风的替代方法而开发的，适用于心房颤动患者，尤其是不适合长期口服抗凝剂治疗的患者。目的：比较经皮经导管心内膜植入 LAAC 的监测麻醉护理（MAC）与 GA 的趋势，并评估与主要麻醉选择相关的独立变量：利用国家麻醉临床结果登记处从美国各地收集的多机构数据：2017-2021年的回顾性数据分析.使用的统计分析：连续变量采用独立样本t检验或曼-惠特尼U检验，分类变量采用卡方检验或费雪精确检验。多变量逻辑回归用于评估患者和医院特征：共有19395名患者接受了手术，352名患者（1.8%）接受了MAC。从 2017 年到 2021 年，MAC 的使用率呈上升趋势（P < 0.0001）。MAC患者的美国麻醉医师协会（ASA）身体状况≥4（33.6% vs 22.89%）、在南方中心接受治疗（67.7% vs 44.2%）、在农村地区接受治疗（71% vs 39.5%）以及年经皮经导管LAAC中位数较低（102 vs 153例）的可能性更大（P均＜0.0001）。在多变量分析中，西部患者接受 MAC 治疗的几率比东北部患者低 85%（AOR：0.15；95% CI 0.03-0.80，P = 0.0261）：虽然GA是经皮经导管封堵左心房阑尾最常用的麻醉技术，但从2017-2021年，MAC出现了少量统计学意义上的显著增加。LAAC的麻醉管理因地理位置而异。
Anesthetic Choice for Percutaneous Transcatheter Closure of the Left Atrial Appendage: A National Anesthesia Clinical Outcomes Registry Analysis.
Context: Left atrial appendage closure (LAAC) was developed as a novel stroke prevention alternative for patients with atrial fibrillation, particularly for those not suitable for long-term oral anticoagulant therapy. Traditionally, general anesthesia (GA) has been more commonly used primarily due to the necessity of transesophageal echocardiography.
Aims: Compare trends of monitored anesthesia care (MAC) versus GA for percutaneous transcatheter LAAC with endocardial implant and assess for independent variables associated with primary anesthetic choice.
Settings and design: Multi-institutional data collected from across the United States using the National Anesthesia Clinical Outcomes Registry.
Material and methods: Retrospective data analysis from 2017-2021.
Statistical analysis used: Independent-sample t tests or Mann-Whitney U tests were used for continuous variables and Chi-square tests or Fisher's exact test for categorical variables. Multivariate logistic regression was used to assess patient and hospital characteristics.
Results: A total of 19,395 patients underwent the procedure, and 352 patients (1.8%) received MAC. MAC usage trended upward from 2017-2021 (P < 0.0001). MAC patients were more likely to have an American Society of Anesthesiologists (ASA) physical status of≥ 4 (33.6% vs 22.89%) and to have been treated at centers in the South (67.7% vs 44.2%), in rural locations (71% vs 39.5%), and with lower median annual percutaneous transcatheter LAAC volume (102 vs 153 procedures) (all P < 0.0001). In multivariate analysis, patients treated in the West had 85% lower odds of receiving MAC compared to those in the Northeast (AOR: 0.15; 95% CI 0.03-0.80, P = 0.0261).
Conclusions: While GA is the most common anesthetic technique for percutaneous transcatheter closure of the left atrial appendage, a small, statistically significant increase in MAC occurred from 2017-2021. Anesthetic management for LAAC varies with geographic location.
期刊介绍：
Annals of Cardiac Anaesthesia (ACA) is the official journal of the Indian Association of Cardiovascular Thoracic Anaesthesiologists. The journal is indexed with PubMed/MEDLINE, Excerpta Medica/EMBASE, IndMed and MedInd. The journal’s full text is online at www.annals.in. With the aim of faster and better dissemination of knowledge, we will be publishing articles ‘Ahead of Print’ immediately on acceptance. In addition, the journal would allow free access (Open Access) to its contents, which is likely to attract more readers and citations to articles published in ACA. Authors do not have to pay for submission, processing or publication of articles in ACA.
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