Supraglottic Airway Use for Transfemoral-Transcatheter Aortic Valve Replacement.

ABSTRACT

OBJECTIVE: Examine outcome differences in patients managed either with a supraglottic airway or an endotracheal tube for general anesthesia during transcatheter aortic valve replacement. The authors hypothesized that patients managed with a supraglottic airway would have shorter post-anesthesia care unit and hospital stays and receive fewer opioids, norepinephrine equivalents, and neuromuscular blocking agents, without an increase in 30-day major adverse cardiovascular events. DESIGN: Retrospective chart review with 12 supraglottic airway-to-endotracheal tube patient propensity score matching. SETTING: Single, urban, tertiary care, academic medical center. PARTICIPANTS: Patients undergoing transfemoral- transcatheter aortic valve replacement between 2017 and 2019. INTERVENTIONS: Supraglottic or endotracheal tube airway management during general anesthesia. MEASUREMENTS AND MAIN RESULTS: Thirty-one supraglottic airway patients were propensity score matched with 62 endotracheal tube patients. There was no significant difference for postanesthesia care unit (p = 0.58) or hospital (p = 0.16) lengths of stay. Supraglottic airway patients received significantly fewer neuromuscular blockers (p < 0.0001) and trended toward fewer opioids (p = 0.05), but received a similar number of norepinephrine equivalents (p = 0.76). The major adverse cardiovascular event odds ratio between groups was 1.39 (p = 0.51). The time under general anesthesia (p = 0.02) and total time in the operating room (p = 0.04) were significantly shorter for supraglottic airway patients. CONCLUSIONS: Supraglottic airway management in transcatheter aortic valve replacement was feasible without an increase in major adverse cardiovascular outcomes compared with endotracheal tube management during general anesthesia. Supraglottic airway patients trended toward receiving fewer opioids and received significantly fewer neuromuscular blockers while also having significantly shorter time under general anesthesia and total time in the operating room.