P369. Use of Conscious Sedation for Thoracic Endovascular Aortic Surgery at a Single Center
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
Beaumont Royal Oak Medical Center
Royal Oak, MI
United States - Contact Me
Bogdan Kindzelski, MD, MS completed his undergraduate education with High Honors at the University of Michigan and his medical school education at the Cleveland Clinic Lerner College of Medicine of CWRU. He completed his residency training in cardiothoracic surgery at the Cleveland Clinic, serving as administrative chief resident. Dr. Kindzelski has over 25 peer reviewed publications and book chapters as well as over a dozen national and international conference presentations and abstracts. Currently, he is staff cardiac and aortic surgeon as well as Assistant Professor of Surgery at Corewell William Beaumont University Hospital in Royal Oak, Michigan.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objective: Local anesthesia with conscious sedation (CS) has shown benefit over general anesthesia (GA) with many different endo-surgical procedures. The nationwide use of CS in thoracic endovascular aortic surgery (TEVAR) is low. We adopted the use of CS for TEVAR in 2016 and explored our institutional results with both approaches.
Methods: From January 2014 to December 2022, 109 patients underwent TEVAR at our institution. 68 (62%) and 41 (38%) cases were done under GA and CS with local, respectively. TEVARs were for the following indications: dissection (61, 56%), aneurysm (37, 34%), transection (5, 5%), penetrating ulcers (5,5%) and coarctation (1,1%). Status of the procedures included: emergent (42, 39%), urgent (26, 24%), elective (41, 38%).
Results: GA was used for 17 elective, 13 urgent, and 38 emergent cases, while for CS, there were 24 elective, 13 urgent, and 4 emergent cases. A femoral cutdown was performed in 9 cases (13%) within the GA group, whereas all cases in the CS group utilized percutaneous access, except for 1 (3%) that required a conversion to femoral cutdown. Preoperative malperfusion was noted in 11 (16%) and 1 (3%) case under GA and CS with local, respectively. Spinal drain usage included 31 (45%) and 30 (73%) within the GA and CS with local groups. Median total operative time (minutes) was 217 (±118) and 224(±65) in the GA and CS groups, respectively. In-hospital morality occurred in 10 (14%) GA and 0 CS patients (p=0.024). There were 18 patients that required prolonged ventilation (>48 hours) in the GA group. Postoperative renal failure was noted in 12 (18%) and 2 (5%) cases under GA and CS with local, respectively. Need for vasopressor use following TEVAR was noted in 26 (38%) and 6 (15%) cases under GA and CS with local. Hospital Length of stay was 7±13 and 7±9 days for GA and CS with local, respectively. Extensive TEVAR, defined as greater than 2 zones of aortic coverage, was done in 44 (65%) GA and 26 (63%) CS with local cases. The same increased in-hospital morality risk remained present in the extensive TEVAR subset with 7 (16%) GA and 0 CS patients (p=0.042). Use of CS in extensive TEVAR was associated with shorter OR times GA (285.3±121.3) vs CS (224.2.2±65.3) (p=0.024).
Conclusions: Most CS TEVAR cases were done in the elective setting. Those that underwent CS for extensive TEVAR at our institution were associated with improved mortality and shorter operative times. When feasible, CS with local for TEVAR is safe and has potential benefits related to outcomes and resource utilization for extensive TEVAR coverage.
Authors
Bogdan Kindzelski (1), Alexander Chen (1), Emanuela Peshel (1), Jeffrey Altshuler (1), O. William Brown (2), Graham Long (2), Paul Bove (2), Maciej Uzieblo (2), Kyle Markel (2), Alessandro Vivacqua (1)
Institutions
(1) Department of Cardiovascular Surgery, Corewell William Beaumont University Hospital, Royal Oak, MI, (2) Department of Vascular Surgery, Corewell William Beaumont University Hospital, Royal Oak, MI
Methods: From January 2014 to December 2022, 109 patients underwent TEVAR at our institution. 68 (62%) and 41 (38%) cases were done under GA and CS with local, respectively. TEVARs were for the following indications: dissection (61, 56%), aneurysm (37, 34%), transection (5, 5%), penetrating ulcers (5,5%) and coarctation (1,1%). Status of the procedures included: emergent (42, 39%), urgent (26, 24%), elective (41, 38%).
Results: GA was used for 17 elective, 13 urgent, and 38 emergent cases, while for CS, there were 24 elective, 13 urgent, and 4 emergent cases. A femoral cutdown was performed in 9 cases (13%) within the GA group, whereas all cases in the CS group utilized percutaneous access, except for 1 (3%) that required a conversion to femoral cutdown. Preoperative malperfusion was noted in 11 (16%) and 1 (3%) case under GA and CS with local, respectively. Spinal drain usage included 31 (45%) and 30 (73%) within the GA and CS with local groups. Median total operative time (minutes) was 217 (±118) and 224(±65) in the GA and CS groups, respectively. In-hospital morality occurred in 10 (14%) GA and 0 CS patients (p=0.024). There were 18 patients that required prolonged ventilation (>48 hours) in the GA group. Postoperative renal failure was noted in 12 (18%) and 2 (5%) cases under GA and CS with local, respectively. Need for vasopressor use following TEVAR was noted in 26 (38%) and 6 (15%) cases under GA and CS with local. Hospital Length of stay was 7±13 and 7±9 days for GA and CS with local, respectively. Extensive TEVAR, defined as greater than 2 zones of aortic coverage, was done in 44 (65%) GA and 26 (63%) CS with local cases. The same increased in-hospital morality risk remained present in the extensive TEVAR subset with 7 (16%) GA and 0 CS patients (p=0.042). Use of CS in extensive TEVAR was associated with shorter OR times GA (285.3±121.3) vs CS (224.2.2±65.3) (p=0.024).
Conclusions: Most CS TEVAR cases were done in the elective setting. Those that underwent CS for extensive TEVAR at our institution were associated with improved mortality and shorter operative times. When feasible, CS with local for TEVAR is safe and has potential benefits related to outcomes and resource utilization for extensive TEVAR coverage.
Authors
Bogdan Kindzelski (1), Alexander Chen (1), Emanuela Peshel (1), Jeffrey Altshuler (1), O. William Brown (2), Graham Long (2), Paul Bove (2), Maciej Uzieblo (2), Kyle Markel (2), Alessandro Vivacqua (1)
Institutions
(1) Department of Cardiovascular Surgery, Corewell William Beaumont University Hospital, Royal Oak, MI, (2) Department of Vascular Surgery, Corewell William Beaumont University Hospital, Royal Oak, MI
Presentation Duration
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