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Deep sedation versus general anesthesia in percutaneous edge-to-edge mitral valve reconstruction using the MitraClip system

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Abstract

Background

Percutaneous edge-to-edge mitral valve reconstruction (PMVR) has emerged as a treatment option in patients with severe mitral regurgitation not considered suitable candidates for surgery. The majority of PMVR procedures are performed under general anesthesia (GA), although deep sedation (DS) appears to be an attractive alternative. We thus sought to assess the impact on intensive care unit (ICU) length of stay, efficacy, and safety of DS in comparison to GA in patients undergoing PMVR using the MitraClip® system.

Methods

Sixty consecutive patients underwent PMVR procedures at two centers. The first 30 patients were treated by GA followed by 30 patients undergoing DS under different settings. The primary clinical endpoint was ICU length of stay. The primary efficacy endpoint included procedural success and procedural duration. The safety endpoint was defined as a composite of death, stroke, cardiogenic shock, moderate and severe bleeding as well as pneumonia.

Results

The ICU length of stay was significantly shorter in the DS group in comparison to GA patients (p = 0.001). The hospital length of stay did not differ following DS in comparison to GA (p = 0.96). Procedural success was high in both groups (100 versus 96.7 %, p = 0.34) at similar procedural duration time (p = 0.60). No difference between GA and DS was observed with respect to the occurrence of the combined safety endpoint (p = 0.47).

Conclusions

In comparison to GA, DS reduces the ICU length of stay in PMVR without negative effects on safety and efficacy. Prospective randomized trials are needed to confirm these findings.

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Acknowledgments

No fund received for this study.

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    Authors and Affiliations

    1. Department of Cardiology, Angiology and Intensive Care Medicine, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Heart Center Luebeck, University Hospital Schleswig–Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany

      Suzanne de Waha, Steffen Desch, Ingo Eitel, Adrian Reinhardt, Janine Pöss, Georg Fuernau & Holger Thiele

    2. German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Lübeck, Germany

      Suzanne de Waha, Steffen Desch, Ingo Eitel, Adrian Reinhardt, Janine Pöss, Georg Fuernau & Holger Thiele

    3. Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany

      Joerg Seeburger, Thilo Noack, Denis Rouven Merk & Friedrich-Wilhelm Mohr

    4. Department of Anesthesiology, Heart Center, University of Leipzig, Leipzig, Germany

      Joerg Ender

    5. Department of Internal Medicine/Cardiology, Heart Center, University of Leipzig, Leipzig, Germany

      Gerhard Schuler

    6. Department of Cardiac and Thoracic Vascular Surgery, University Heart Center Luebeck, University Hospital Schleswig–Holstein, Lübeck, Germany

      Hans-Hinrich Sievers

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    1. Suzanne de Waha
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    Correspondence to Suzanne de Waha.

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    The authors have no conflict of interest to declare with respect to the current study.

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    S. de Waha and J. Seeburger contributed equally to this work.

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    de Waha, S., Seeburger, J., Ender, J. et al. Deep sedation versus general anesthesia in percutaneous edge-to-edge mitral valve reconstruction using the MitraClip system. Clin Res Cardiol 105, 535–543 (2016). https://doi.org/10.1007/s00392-015-0951-z

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    • DOI: https://doi.org/10.1007/s00392-015-0951-z

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