ABSTRACT
Introduction:
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.
Methods:
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.
Results:
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.
Conclusion:
GDFT in the intervention group was associated with a reduced
incidence of postinterventional
delirium.