General Anesthesia Ups Heart Failure Risk Post-Valve Surgery

TOPLINETranscatheter aortic valve replacement (TAVR) patients who received general anesthesia had a higher incidence of heart failure at 1 year than those who received nongeneral anesthesia.METHODOLOGYResearchers conducted a retrospective observational cohort study using data from the TriNetX Global Collaborative Network, including adults who underwent their first TAVR from 2015 to 2024.Patients either received general or nongeneral anesthesia, the latter of which was comprised of moderate sedation or nerve block, regional, epidural, local, or injection anesthesia.A target trial emulation framework was used to compare the two types of anesthesia, and 1:1 propensity score matching was used to balance baseline characteristics.A total of 1793 patients were included in each anesthesia group (mean age, 78.7 years; 44.6% women; more than 90% White individuals).Clinical outcomes assessed at 30, 90, and 365 days included all-cause mortality, acute kidney injury, major vascular complications, respiratory failure, and hospital readmission.TAKEAWAYAt 1 year, the incidence of heart failure was higher in the general anesthesia group than in those who received nongeneral anesthesia (HR, 1.44; P = .023).At 1 month after TAVR, all-cause mortality did not differ between patient groups (hazard ratio [HR], 1.19; P = .300), and no differences were observed in rates of stroke, kidney injury, myocardial infarction, atrial fibrillation, major vascular complications, heart failure, or respiratory failure.At 90 and 365 days, all-cause mortality and most major complications did not differ between groups.IN PRACTICE“[The study] findings support the safety and feasibility of less invasive anesthetic approaches and highlight the potential for improved early postoperative recovery and resource utilization,” the authors wrote.SOURCEThe study was led by Mahmoud S. Mohamed, MD, and Osama Abu-Shawer, MD, MS, from the Case Western Reserve University School of Medicine in Cleveland. It was published online on July 20 in the Journal of Clinical Anesthesia.LIMITATIONSSpecific details about the procedure, such as valve type, access route, duration of procedure, and the types of anesthesia used were not consistently recorded. Changes from nongeneral anesthesia to general anesthesia during operations could not be reliably identified. Information on length of stay, postoperative confusion, cognitive changes, and quality of life was not consistently available.DISCLOSURESNo specific funding was reported in the study. The authors declared having no conflicts of interest.This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.