Supraglottic airway versus endotracheal tube for transesophageal echocardiography guided watchman procedures
Context: Atrial fibrillation (AF) is the most common arrhythmia in adults. For over 90% of non-valvular AF patients, the left atrial appendage is the primary site of thrombus formation. Left atrial appendage occlusion using the FDA-approved Watchman™ device has been shown to have better clinical out...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2021-01-01
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| Series: | Annals of Cardiac Anaesthesia |
| Subjects: | |
| Online Access: | http://www.annals.in/article.asp?issn=0971-9784;year=2021;volume=24;issue=3;spage=345;epage=352;aulast=Musuku |
| _version_ | 1818613705222389760 |
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| author | Sridhar Reddy Musuku Isha Doshi Dmitriy Yukhvid Christopher A Di Capua Alexander D Shapeton |
| author_facet | Sridhar Reddy Musuku Isha Doshi Dmitriy Yukhvid Christopher A Di Capua Alexander D Shapeton |
| author_sort | Sridhar Reddy Musuku |
| collection | DOAJ |
| description | Context: Atrial fibrillation (AF) is the most common arrhythmia in adults. For over 90% of non-valvular AF patients, the left atrial appendage is the primary site of thrombus formation. Left atrial appendage occlusion using the FDA-approved Watchman™ device has been shown to have better clinical outcomes with minimal post-procedural complications when compared to warfarin therapy for patients with contraindications to anticoagulation. Traditionally, this procedure requires an endotracheal tube (ETT) to facilitate transesophageal echocardiography (TEE) guidance. However, recently supraglottic airway (SGA) has emerged as a feasible, non-inferior alternative to ETT for procedures requiring TEE.
Aims: Compare outcomes between TEE guided Watchman™ procedures performed with a SGA versus ETT.
Settings and Design: A single tertiary care academic medical center.
Methods and Materials: Retrospective Observational Study comparing SGA and ETT patients.
Statistical Analysis Used: 1:4 propensity score matching of SGA and ETT patients.
Results: 42 SGA patients were matched with 155 ETT patients. All patients underwent procedure with TEE. SGA patients had shorter operating room time (11 min difference, P = 0.00001) and considerably shorter PACU length of stays (45 min difference, P = 0.024). Statistically significant, but clinically trivial differences were seen in procedure times (P = 0.015) and fluoroscopy times (P = 0.017). Patients in the SGA group received lower fentanyl (P < 0.00001) dosages. No significant differences were observed in postoperative complications, organ-specific morbidity or 30-day mortality.
Conclusions: General anesthesia with SGA is likely a safe, feasible alternative to ETT in Watchman™ procedures requiring TEE guidance. Use of SGA was associated with significant reductions in operating room time and PACU length of stay, potentially offering advantages in terms of resource utilization. |
| first_indexed | 2024-12-16T16:06:22Z |
| format | Article |
| id | doaj.art-38386d6c62e943c7aa7bc1a924819ddc |
| institution | Directory Open Access Journal |
| issn | 0971-9784 |
| language | English |
| last_indexed | 2024-12-16T16:06:22Z |
| publishDate | 2021-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Annals of Cardiac Anaesthesia |
| spelling | doaj.art-38386d6c62e943c7aa7bc1a924819ddc2022-12-21T22:25:21ZengWolters Kluwer Medknow PublicationsAnnals of Cardiac Anaesthesia0971-97842021-01-0124334535210.4103/aca.ACA_201_20Supraglottic airway versus endotracheal tube for transesophageal echocardiography guided watchman proceduresSridhar Reddy MusukuIsha DoshiDmitriy YukhvidChristopher A Di CapuaAlexander D ShapetonContext: Atrial fibrillation (AF) is the most common arrhythmia in adults. For over 90% of non-valvular AF patients, the left atrial appendage is the primary site of thrombus formation. Left atrial appendage occlusion using the FDA-approved Watchman™ device has been shown to have better clinical outcomes with minimal post-procedural complications when compared to warfarin therapy for patients with contraindications to anticoagulation. Traditionally, this procedure requires an endotracheal tube (ETT) to facilitate transesophageal echocardiography (TEE) guidance. However, recently supraglottic airway (SGA) has emerged as a feasible, non-inferior alternative to ETT for procedures requiring TEE. Aims: Compare outcomes between TEE guided Watchman™ procedures performed with a SGA versus ETT. Settings and Design: A single tertiary care academic medical center. Methods and Materials: Retrospective Observational Study comparing SGA and ETT patients. Statistical Analysis Used: 1:4 propensity score matching of SGA and ETT patients. Results: 42 SGA patients were matched with 155 ETT patients. All patients underwent procedure with TEE. SGA patients had shorter operating room time (11 min difference, P = 0.00001) and considerably shorter PACU length of stays (45 min difference, P = 0.024). Statistically significant, but clinically trivial differences were seen in procedure times (P = 0.015) and fluoroscopy times (P = 0.017). Patients in the SGA group received lower fentanyl (P < 0.00001) dosages. No significant differences were observed in postoperative complications, organ-specific morbidity or 30-day mortality. Conclusions: General anesthesia with SGA is likely a safe, feasible alternative to ETT in Watchman™ procedures requiring TEE guidance. Use of SGA was associated with significant reductions in operating room time and PACU length of stay, potentially offering advantages in terms of resource utilization.http://www.annals.in/article.asp?issn=0971-9784;year=2021;volume=24;issue=3;spage=345;epage=352;aulast=Musukuatrial fibrillationechocardiographysupraglottic airwayteewatchman™ procedure |
| spellingShingle | Sridhar Reddy Musuku Isha Doshi Dmitriy Yukhvid Christopher A Di Capua Alexander D Shapeton Supraglottic airway versus endotracheal tube for transesophageal echocardiography guided watchman procedures Annals of Cardiac Anaesthesia atrial fibrillation echocardiography supraglottic airway tee watchman™ procedure |
| title | Supraglottic airway versus endotracheal tube for transesophageal echocardiography guided watchman procedures |
| title_full | Supraglottic airway versus endotracheal tube for transesophageal echocardiography guided watchman procedures |
| title_fullStr | Supraglottic airway versus endotracheal tube for transesophageal echocardiography guided watchman procedures |
| title_full_unstemmed | Supraglottic airway versus endotracheal tube for transesophageal echocardiography guided watchman procedures |
| title_short | Supraglottic airway versus endotracheal tube for transesophageal echocardiography guided watchman procedures |
| title_sort | supraglottic airway versus endotracheal tube for transesophageal echocardiography guided watchman procedures |
| topic | atrial fibrillation echocardiography supraglottic airway tee watchman™ procedure |
| url | http://www.annals.in/article.asp?issn=0971-9784;year=2021;volume=24;issue=3;spage=345;epage=352;aulast=Musuku |
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