RESUMEN
BACKGROUND: Many studies have suggested that volatile anesthetic use may improve postoperative outcomes after cardiac surgery compared to total intravenous anesthesia (TIVA) owing to its potential cardioprotective effect. However, the results were inconclusive, and few studies have included patients undergoing heart valve surgery. METHODS: This nationwide population-based study included all adult patients who underwent heart valve surgery between 2010 and 2019 in Korea based on data from a health insurance claim database. Patients were divided based on the use of volatile anesthetics: the volatile anesthetics or TIVA groups. After stabilized inverse probability of treatment weighting (IPTW), the association between the use of volatile anesthetics and the risk of cumulative 1-year all-cause mortality (the primary outcome) and cumulative long-term (beyond 1 year) mortality were assessed using Cox regression analysis. RESULTS: Of the 30,755 patients included in this study, the overall incidence of 1-year mortality was 8.5%. After stabilized IPTW, the risk of cumulative 1-year mortality did not differ in the volatile anesthetics group compared to the TIVA group (hazard ratio, 0.98; 95% confidence interval, 0.90-1.07; P = .602), nor did the risk of cumulative long-term mortality (hazard ratio, 0.98; 95% confidence interval, 0.93-1.04; P = .579) at a median (interquartile range) follow-up duration of 4.8 (2.6-7.6) years. CONCLUSIONS: Compared with TIVA, volatile anesthetic use was not associated with reduced postoperative mortality risk in patients undergoing heart valve surgery. Our findings indicate that the use of volatile anesthetics does not have a significant impact on mortality after heart valve surgery. Therefore, the choice of anesthesia type can be based on the anesthesiologists' or institutional preference and experience.
Asunto(s)
Anestesia Intravenosa , Anestésicos por Inhalación , Válvulas Cardíacas , Humanos , Masculino , Femenino , Persona de Mediana Edad , Anestesia Intravenosa/efectos adversos , Anestesia Intravenosa/mortalidad , Anciano , Anestésicos por Inhalación/administración & dosificación , Anestésicos por Inhalación/efectos adversos , República de Corea/epidemiología , Válvulas Cardíacas/cirugía , Adulto , Procedimientos Quirúrgicos Cardíacos/mortalidad , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Resultado del Tratamiento , Estudios Retrospectivos , Bases de Datos Factuales , Factores de Riesgo , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/epidemiología , Anestesia por Inhalación/efectos adversos , Anestesia por Inhalación/mortalidad , Factores de TiempoRESUMEN
Aunque la anestesia total intravenosa puede ser una alternativa a la inhalatoria o balanceada, se precisan más estudios para delimitar cuales son realmente sus ventajas