Objective

Epidural analgesia improves outcomes of patients undergoing transapical aortic valve implantation (TA-AVI). However, its use is limited due to concerns of serious complications while patients are on antiplatelet and anticoagulant medication. Spinal analgesia (SA) is generally associated with fewer complications. We report on our experience with SA in patients undergoing TA-AVI.

Methods

All TA-AVI patients received general anaesthesia at our centre. Since 2013, additional single-shot SA using a long acting opioid plus local anaesthetic intrathecally was introduced as a standard of care during TA-AVI procedures (n=26) unless contraindicated. We compared results of patients undergoing TA-AVI with and without SA (SA n=26 and non-SA n=110).

Results

No SA related complication occurred. No death occurred up to 30-days post-procedure in the SA cohort compared to 18 deaths in non-SA cohort (16.4%, p =0.02). Postoperative increase in creatinine was lower with SA (18.5±36.3mmol/l vs. 53.2±74.7mmol/l, p=0.02). Respiratory failure did not occur in the SA-cohort, compared to 14 patients in non-SA (12.7%, p=0.05). New onset atrial fibrillation (AF) occurred in 3.8% of patients after SA vs. 16.4% in non-SA patients (p=0.09).

Conclusion

The use of SA in patients undergoing TA-AVI is safe. In addition to the growing experience with TA-AVI and its peri-procedural management, the introduction of SA has led to improved outcomes after TA-AVI at our centre, as all-cause mortality, renal- and pulmonary complications were lower. SA in TA-TAVI patients enables earlier mobilisation and perhaps a reduction of inflammatory response caused by thoracotomy. Further studies with larger patient numbers are needed to confirm our findings.