ITACTA for - Outcome Research

ITACTA for
f
M Ranucci, F Guarracino, RD Covello
IRCCS Policlinico San Donato, Milan
Azienda Ospedaliera Universitaria Pisana, Pisa
IRCCS Ospedale San Raffaele
Raffaele, Milan
ITACTA
SOCIETA’ ITALIANA di ANESTESIA e
TERAPIA INTENSIVA CARDIOTORACICA e
VASCOLARE
(italian EACTA chapter)
ITACTA
HEART TEAM
Which anesthesia for TAVI?
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General anesthesia
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Local anesthesia (MAC)
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•
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procedural TOE allowed
facilitated management of complications
no disconfort or pain for catheters placement
and long time procedure
no anxiety because of RVP and decreased
cerebral blood flow
no patient’s movement
control of respiratory intereferences
more stable hemodynamics
IOT and mechanical ventilation avoided
continuous neurologic monitoring
shorter preparation time, operative time, and
recovery time
reduced need for ICU
possible shorter hospital stay and lower
costs
Anesthesia depends on
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learning curve
patient’s characteristics
p
a suggestion from a proctor
a bad experience with one of our early
anesthesia cases
• a run of good fortune
• regional differences
Anesthesia may impact on
• operative strategies
• outcomes
• use of resources and costs
Lessons from the practice
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there are risks intrinsic to the anaesthetic intervention
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these risks vary
y according
g to the p
physiological
y
g
condition of the
individual
•
the outcome of an intervention may
y varyy according
g to the choice of
anaesthetic management
•
different teams may
y have different outcomes with different
anaesthetic techniques
•
some events are so damaging
g g for a p
patient that the anaesthetic
technique effectively becomes irrelevant
•
resources utilization and costs should be considered
Local vs general anesthesia:
what’s in the literature?
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Linke A, et al. European Society of Cardiology ESC 2012 (abstract)
M tl h LJ
Motloch
LJ, ett al.
l Clin
Cli R
Res C
Cardiol.
di l 2012;101:45-53
2012 101 45 53
Yamamoto M, et al. Am J Cardiol. 2013;111:94-99
Behan M, et al. Catheter Cardiovasc Interv. 2008;72:1012-5
Ben-Dor I, et al. Cardiovasc Revasc Med. 2012;13:207-10
Covello RD, et al. Minerva anestesiol. 2010;76:100-108
Dehedin B
B, et al
al. J Cardiothorac Vasc Anesth
Anesth. 2011;25:1036-43
2011;25:1036 43
OBSERVANT
Enlisted Centers
Participating Centers
Cardiac Surgery
Centers
Hemodynamic
Centers
95
61
61
34
Total
7799
SAVR
5864
TAVI
1935
TAVI
AG
35%
AL
65%
Database analysis
+
Survey
(who, how, and why?)
Less invasive
Safe
Effective
Thank you