トランスキャテーターによる大動脈弁移植における意識的鎮静による全身麻酔と局所麻酔:ランダム化SOLVE-TAVI試験
Holger Thiele1,2, Thomas Kurz3,4, Hans-Josef Feistritzer1,2
1Heart Center Leipzig at University of Leipzig, Germany (H.T., H.-J.F., G.S., P.H., P.L., M.A.-W., M.S., D.H., M.B., J.E., S.D.).
Circulation
|August 22, 2020
まとめ
意識的な鎮静 (CS) は,通管性大動脈弁置換のための全身麻酔 (GA) と同様に安全で有効です. この研究では,手術中にCSとGAを投与された患者で同様の結果が見られました.
科学分野:
- 心臓病科
- 麻酔科
- 介入心臓科
背景:
- トランスキャテーター大動脈弁置換 (TAVR) は,意識的な鎮静 (CS) による局所麻酔で頻繁に行われます.
- TAVRの安全性と有効性について,CSと全身麻酔 (GA) を比較したランダム化データは,以前は入手できませんでした.
研究 の 目的:
- 意識的鎮静 (CS) と全身麻酔 (GA) の安全性と有効性を比較するために,トランスフェモラルカテーテル大動脈弁置換 (TAVR) を受けている患者.
主な方法:
- SOLVE- TAVI試験は多センターのランダム化試験で,トランスフェモラルTAVRを受けた大動脈狭窄症患者の447人が参加した.
- 患者はCSまたはGAにランダムに分けられました.
- 死亡率,脳卒中,心筋梗塞,感染症,急性腎臓損傷を30日後に組み合わせて評価した.
主要な成果:
- 主要複合エンドポイントは,CS患者の27. 2%とGA患者の26. 4%で発生し,同値を示した (P=0. 015).
- CSとGAのグループでは,個々のコンポーネントのイベント率が似ていた.
- CSは,イノトロップ薬や血管圧縮薬の必要性が著しく低下した (62. 8% vs 97. 3%) と関連付けられました.
結論:
- 意識的な鎮静 (CS) は,トランスフェモラルTAVRの全身麻酔 (GA) と比較して,同様の有効性と安全性結果をもたらします.
- これらの発見は,TAVRの手順におけるCSの安全な適用を支持する.
- この研究は,TAVRにおける麻酔剤の選択のための重要なランダム化データを提供します.
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