Target-controlled infusion during MitraClip procedures in deep-sedation with spontaneous breathing

Area of Science:

• Cardiology
• Anesthesiology
• Interventional Cardiology

Background:

• Percutaneous mitral valve repair using the MitraClip system is a key alternative for high-risk surgical patients.
• MitraClip procedures can be safely performed under general anesthesia (GA) or deep sedation (DS) with spontaneous breathing.
• Anesthesia management impacts procedural outcomes, hemodynamic stability, and patient recovery.

Purpose of the Study:

• To compare the benefits of target-controlled infusion (TCI) of remifentanil and propofol during deep sedation (DS) versus manual total intravenous anesthesia (TIVA) during general anesthesia (GA) in MitraClip patients.
• To evaluate the impact on remifentanil dosage, hemodynamic profile, adverse events, and hospital stay.

Main Methods:

• A comparative study involving 54 patients undergoing transcatheter MitraClip repair from March 2013 to June 2015.
• Twenty-seven patients received DS via TCI with propofol and remifentanil.
• Twenty-seven patients received GA with TIVA using propofol and remifentanil.

Main Results:

• Acute procedural success was 100% in both groups.
• The DS-TCI group showed a significant reduction in remifentanil dose (249 µg vs. 2865 µg, p < 0.01).
• DS-TCI also decreased the need for vasopressors (29.6% vs. 63%, p = 0.03) and reduced hypotension (p = 0.08), with no significant difference in hospital stay (5.4 vs. 5.8 days).

Conclusions:

• Target-controlled infusion (TCI) of remifentanil for deep sedation (DS) in spontaneously breathing patients provides stable anesthetic conditions for MitraClip procedures.
• DS-TCI requires lower drug dosages, enhances hemodynamic stability, and leads to fewer adverse events compared to GA with TIVA.
• This anesthesia approach is a beneficial alternative for MitraClip interventions.