• Kenta Okitsu, Takeshi Iritakenishi, Tatsuyuki Imada, Michioki Kuri, Shibata Sho Carl SC Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 5650871, Japan., and Yuji Fujino.
• Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 5650871, Japan. kokitsu@anes.med.osaka-u.ac.jp.
• J Anesth. 2018 Feb 1; 32 (1): 82-89.

PurposeThis study aimed to reveal whether the occurrence of periprocedural myocardial damage (PMD) decreases in patients who received volatile anesthetics to maintain general anesthesia compared with those who received propofol during transcatheter aortic valve implantation (TAVI).MethodsWe included one hundred and forty adult patients who underwent transfemoral TAVI under general anesthesia from January 2015 to March 2017 in this single-center retrospective review. We compared the rate of patients who developed PMD between those who received desflurane (Group D, n = 72) and propofol (Group P, n = 68) for anesthetic maintenance. PMD was represented by the peak levels of creatine kinase myocardial band (CK-MB) and troponin I within 72 h following the procedure and defined as an increase >5 times in CK-MB or >15 times in troponin I compared with the institutional upper reference limits. Further analysis was performed to identify the independent predictors of PMD.ResultsThere was no significant difference in the rate of PMD between groups (Group D 72.2% to Group P 70.6%, P = 0.85) or levels of CK-MB (Group D 7.85 [1.3-72.7] ng/mL to Group P 8.45 [1.8-49.7] ng/mL; P = 0.59) and troponin I (Group D 1.061 [0.050-10.8] ng/mL to Group P 1.214 [0.036-29.0] ng/mL; P = 0.97). The risk of PMD was higher in patients with more intraprocedural blood loss (odds ratio 1.49 per 100 mL, P = 0.048) and lower in those with an implanted permanent pacemaker (odds ratio 0.17; P = 0.02).ConclusionsDesflurane does not appear to be more cardioprotective than propofol when used for anesthetic maintenance in patients undergoing transfemoral TAVI.

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