Feasibility of Goal-Directed Fluid Therapy in Patients with Transcatheter Aortic Valve Replacement - An Ambispective Analysis

TL;DR

This study examines whether goal-directed fluid therapy can be used in TAVR patients under general anesthesia and its effects on outcomes like delirium.

Contribution

The study demonstrates the feasibility of GDFT in TAVR patients and its potential to reduce postoperative delirium.

Findings

GDFT increased stroke volume in TAVR patients.

GDFT was associated with a reduced incidence of postinterventional delirium.

The intervention group had a shorter duration of anesthesia.

Abstract

Goal-directed fluid therapy (GDFT) has been shown to reduce postoperative
complications. The feasibility of GDFT in transcatheter aortic valve
replacement (TAVR) patients under general anesthesia has not yet been
demonstrated. We examined whether GDFT could be applied in patients
undergoing TAVR in general anesthesia and its impact on outcomes.

Forty consecutive TAVR patients in the prospective intervention group with
GDFT were compared to 40 retrospective TAVR patients without GDFT. Inclusion
criteria were age ≥ 18 years, elective TAVR in general anesthesia, no
participation in another interventional study. Exclusion criteria were lack
of ability to consent study participation, pregnant or nursing patients,
emergency procedures, preinterventional decubitus, tissue and/or extremity
ischemia, peripheral arterial occlusive disease grade IV, atrial
fibrillation or other severe heart rhythm disorder, necessity of usage of
intra-aortic balloon pump. Stroke volume and stroke volume variation were
determined with uncalibrated pulse contour analysis and optimized according
to a predefined algorithm using 250 ml of hydroxyethyl starch.

Stroke volume could be increased by applying GDFT. The intervention group
received more colloids and fewer crystalloids than control group. Total
volume replacement did not differ. The incidence of overall complications as
well as intensive care unit and hospital length of stay were comparable
between both groups. GDFT was associated with a reduced incidence of
delirium. Duration of anesthesia was shorter in the intervention group.
Duration of the interventional procedure did not differ.

GDFT in the intervention group was associated with a reduced incidence of
postinterventional delirium.

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