• Paul Theron, Kaushik Guha, Lilian Mantziari, Salman Salahuddin, Rakesh Sharma, and Sian Jaggar.
• Department of Anesthesia, Royal Brompton Hospital, London, United Kingdom. Electronic address: paultheron@gmail.com.
• J. Cardiothorac. Vasc. Anesth.. 2014 Apr 1;28(2):280-4.

ObjectiveHeart failure carries significant risk for major noncardiac surgery. Whether this risk is transferable to minor surgery is less well-documented. Thus, the aim of this study was to assess the outcome of a contemporary cohort of heart failure patients undergoing cardiac resynchronization therapy (CRT) device insertion under general anesthesia or sedation.DesignRetrospective observational study.SettingTertiary cardiac specialist hospital.ParticipantsHeart failure patients.InterventionsCRT insertion under general anesthesia or sedation.Measurements And Main ResultsAnesthesia, heart failure, and outcome data were collected on a consecutive series of patients having CRT device insertion between 2002 and 2010. A total of 242 patients were managed by the anesthesia department during the study period. After exclusion criteria were applied, data for 183 patients were analyzed. Immediate perioperative (<24 hours) mortality was zero; 30-day mortality of 138 patients was 2.2%. One patient (0.5%) required unplanned intensive care admission. A comparison was made between the sedation (n = 76) group and the general anesthesia (GA) group (n = 107). When compared with the sedation group, the GA group had more intraoperative hypotension (26.2% versus 4.0%, p<0.00001). There was no difference between the GA and sedation groups with regard to 30-day mortality (1.4% versus 3.1%, p = 0.57), unplanned intensive care admission (0% versus 1.3%, p = 0.42), and length of stay in days (3 versus 3, p = 0.82).ConclusionThe authors found that patients with heart failure undergoing CRT insertion with concurrent general anesthesia or sedation had minimal immediate perioperative risk and that there was no difference in postoperative outcome between general anesthesia and sedation.Copyright © 2014 Elsevier Inc. All rights reserved.

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