ERRATUM
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Erratum to “Comparing outcomes of general anesthesia and monitored anesthesia care during transcatheter aortic valve replacement: The Cleveland Clinic Foundation experience”
First published: 04 October 2022
This erratum corrects the following:
Sammour Y, Kerrigan J, Banerjee K, et al. Comparing outcomes of general anesthesia and monitored anesthesia care during transcatheter aortic valve replacement: The Cleveland Clinic Foundation experience. Catheter Cardiovasc Interv. 2021;Sep 98(3):E436-E443. 10.1002/ccd.29496
In the aforementioned article, Tables 1–6 were omitted. These tables are presented below.
| GA (n = 560) | MAC (n = 438) | p Value | |
|---|---|---|---|
| A. Baseline demographics and comorbidities | |||
| Age, mean (SD) | 80 (10.2) | 81 (9) | 0.131 |
| Males, n (%) | 314 (56.1%) | 259 (59.1%) | 0.332 |
| Caucasians, n (%) | 531 (94.8%) | 419 (95.7%) | 0.538 |
| BMI, mean (SD) | 28.7 (7) | 29 (9) | 0.543 |
| STS risk score (%), mean (SD) | 7.6 (4.5) | 6.7 (4.3) | 0.004 |
| KCCQ-12 overall summary score, mean (SD) | 49.2 (24.8) | 54.3 (24.6) | 0.002 |
| Hypertension, n (%) | 504 (90%) | 391 (89.5%) | 0.786 |
| Diabetes, n (%) | 208 (37.1%) | 153 (35%) | 0.487 |
| Chronic dialysis, n (%) | 15 (2.7%) | 19 (4.3%) | 0.150 |
| Chronic lung disease, n (%) | 248 (45.8%) | 176 (40.5%) | 0.097 |
| Prior 2-week heart failure, n (%) | 396 (70.7%) | 270 (61.9%) | 0.003 |
| Prior 2-week NYHA class, n (%) | 0.019 | ||
| Class I | 3 (0.5%) | 0 (0%) | |
| Class II | 80 (14.3%) | 52 (11.9%) | |
| Class III | 421 (75.2%) | 360 (82.2%) | |
| Class IV | 56 (10%) | 26 (5.9%) | |
| CAD presentation, n (%) | <0.001 | ||
| No angina | 408 (73.1%) | 379 (86.5%) | |
| Stable angina | 146 (26.2%) | 55 (12.6%) | |
| Unstable angina/NSTEMI | 4 (0.7%) | 4 (0.9%) | |
| Prior MI, n (%) | 154 (27.6%) | 110 (25.1%) | 0.378 |
| Prior PCI, n (%) | 191 (34.2%) | 147 (33.6%) | 0.861 |
| Prior CABG, n (%) | 182 (32.6%) | 117 (26.8%) | 0.046 |
| Number of diseased coronary vessels, n (%) | 0.001 | ||
| 0 | 181 (32.3%) | 157 (35.8%) | |
| 1 | 96 (17.1%) | 72 (16.4%) | |
| 2 | 95 (17%) | 63 (14.4%) | |
| 3 | 142 (25.4%) | 135 (30.8%) | |
| Left main disease, n (%) | 67 (13.2%) | 54 (12.7%) | 0.847 |
| Proximal LAD disease, n (%) | 95 (21%) | 97 (23%) | 0.483 |
| Prior stroke, n (%) | 78 (13.9%) | 47 (10.8%) | 0.133 |
| Prior PAD, n (%) | 222 (39.8%) | 159 (36.4%) | 0.273 |
| Atrial fibrillation/flutter, n (%) | 272 (48.6%) | 199 (45.4%) | 0.324 |
| Prior PPM, n (%) | 101 (18%) | 75 (17.2) | 0.72 |
| B. Baseline echocardiographic parameters | |||
| Left ventricular ejection fraction (LVEF) (%), mean (SD) | 52.5 (13.6) | 55.3 (12.5) | 0.001 |
| Left ventricular diameter during diastole (LVDd) (cm), mean (SD) | 4.7 (0.9) | 4.5 (0.8) | <0.001 |
| Posterior wall thickness during diastole (PWTd) (cm), mean (SD) | 1.2 (0.3) | 1.2 (0.2) | 0.104 |
| Interventricular septum during diastole (IVSd) (cm), mean (SD) | 1.4 (0.3) | 1.3 (0.3) | 0.026 |
| Right ventricular systolic pressure (RVSP) (mmHg), mean (SD) | 46.3 (16.7) | 45 (15.5) | 0.262 |
| Number of native aortic valve leaflets, n (%) | 0.373 | ||
| Tricuspid | 542 (96.8%) | 419 (95.7%) | |
| Bicuspid | 17 (3%) | 19 (4.3%) | |
| AV area (cm2) | 0.6 (0.2) | 0.7 (0.2) | 0.041 |
| AV peak velocity (m/s) | 4.2 (0.8) | 4.2 (0.7) | 0.726 |
| AV mean gradient (mmHg), mean (SD) | 45.2 (16) | 45.4 (16.3) | 0.835 |
| AV peak gradient (mmHg), mean (SD) | 74.9 (24.4) | 74.1 (23.4) | 0.633 |
| Aortic regurgitation, n (%) | 0.315 | ||
| None/trivial (0–0.5+) | 249 (44.7%) | 184 (42.2%) | |
| Mild (1+) | 184 (33%) | 164 (37.6%) | |
| Moderate to severe (≥2+) | 124 (22.1%) | 88 (20.1%) | |
| Moderate-to-severe aortic regurgitation (≥2+), n (%) | 124 (22.1%) | 88 (20.1%) | 0.432 |
| Moderate-to-severe mitral regurgitation (≥2+), n (%) | 223 (39.9%) | 106 (24.2%) | <0.001 |
| Moderate-to-severe tricuspid regurgitation (≥2+), n (%) | 191 (34.1%) | 119 (27.2%) | 0.019 |
| C. Procedural details | |||
| Valve type, n (%) | <0.001 | ||
| Edwards SAPIEN | 137 (24.7%) | 137 (24.7%) | |
| Edwards SAPIEN-XT | 111 (20%) | 83 (18.9%) | |
| Edwards SAPIEN-3 | 238 (43%) | 320 (73.1%) | |
| CoreValve | 37 (6.7%) | 6 (1.4%) | |
| CoreValve Evolut R | 31 (5.6%) | 29 (6.6%) | |
| Valve size, n (%) | 0.012 | ||
| 20 mm | 6 (1.3%) | 8 (1.8%) | |
| 23 mm | 152 (31.9%) | 139 (31.8%) | |
| 26 mm | 205 (43.1%) | 164 (37.5%) | |
| 29 mm | 97 (20.4%) | 122 (27.9%) | |
| 31 mm | 15 (3.2%) | 3 (0.7%) | |
| 34 mm | 1 (0.2%) | 1 (0.2%) | |
| Valve-in-valve, n (%) | 38 (7.8%) | 41 (9.4%) | 0.403 |
| Non-elective TAVR, n (%) | 55 (9.8%) | 15 (3.4%) | <0.001 |
- Abbreviations: AV, aortic valve; BMI, body mass index; CABG, coronary artery bypass grafting; CAD, coronary artery disease; GA, general anesthesia; KCCQ, Kansas City Cardiomyopathy Questionnaire; LVEF, left ventricular ejection fraction; MAC, monitored anesthesia care; MI, myocardial infarction; NSTEMI, non-ST elevation myocardial infarction; NYHA, New York Heart Association; PAD, peripheral artery disease; PCI, percutaneous coronary intervention; SD, standard deviation; STS, Society of Thoracic Surgeons; TAVR, transcatheter aortic valve replacement.
| GA (n = 560) | MAC (n = 438) | p Value | |
|---|---|---|---|
| Fentanyl, n (%) | 507 (90.5%) | 345 (78.8%) | <0.001 |
| Propofol, n (%) | 157 (28%) | 183 (41.8%) | <0.001 |
| Midazolam, n (%) | 159 (28.4%) | 255 (58.2%) | <0.001 |
| Dexmedetomidine, n (%) | 21 (3.8%) | 307 (70.1%) | <0.001 |
| Isoflurane, n (%) | 446 (79.6%) | 0 (0%) | <0.001 |
| Sevoflurane, n (%) | 110 (19.6%) | 0 (0%) | <0.001 |
| Desflurane, n (%) | 4 (0.7%) | 0 (0%) | 0.076 |
| Succinylcholine, n (%) | 108 (19.3%) | 0 (0%) | <0.001 |
| Rocuronium, n (%) | 517 (92.3%) | 0 (0%) | <0.001 |
| Cisatracurium, n (%) | 19 (3.4%) | 0 (0%) | <0.001 |
- Abbreviations: GA, general anesthesia; MAC, monitored anesthesia care.
| GA (n = 560) | MAC (n = 438) | p Value | |
|---|---|---|---|
| Vasopressors and inotropes, n (%) | 359 (64.1%) | 85 (19.4%) | <0.001 |
| Phenylephrine, n (%) | 235 (42%) | 36 (8.2%) | <0.001 |
| Norepinephrine, n (%) | 201 (35.9%) | 58 (13.2%) | <0.001 |
| Epinephrine, n (%) | 75 (13.4%) | 10 (2.3%) | <0.001 |
| Vasopressin, n (%) | 35 (6.3%) | 3 (0.7%) | <0.001 |
| Dobutamine, n (%) | 3 (0.5%) | 1 (0.2%) | 0.446 |
| Milrinone, n (%) | 8 (1.4%) | 1 (0.2%) | 0.047 |
| Central venous catheters, n (%) | 170 (30.4%) | 126 (28.8%) | <0.001 |
| Pulmonary artery catheters, n (%) | 332 (66.5%) | 56 (29.8%) | <0.001 |
- Abbreviations: GA, general anesthesia; MAC, monitored anesthesia care.
| GA (n = 560) | MAC (n = 438) | p Value | |
|---|---|---|---|
| Procedural time (min), mean (SD) | 135 (64.6) | 96.9 (30.9) | <0.001 |
| Fluoroscopy time (min), mean (SD) | 29 (18.7) | 20.4 (8.9) | <0.001 |
| Contrast volume (cc), mean (SD) | 60.4 (43) | 45.5 (27) | <0.001 |
| Cumulative air kerma (mGy), mean (SD) | 1573 (1250) | 962 (621) | <0.001 |
| Dose area product (cGy cm2), mean (SD) | 20,630 (16,276) | 12,869 (8099) | <0.001 |
| Need for intraoperative blood products, n (%) | 49 (8.8%) | 9 (2.1%) | <0.001 |
| Need for intraoperative vasopressors and inotropes, n (%) | 359 (64.1%) | 85 (19.4%) | <0.001 |
| Device success, n (%) | 536 (96.4%) | 433 (98.9%) | 0.014 |
| Conversion to open heart surgery, n (%) | 6 (1.1%) | 4 (0.9%) | 0.795 |
| Valve embolization, n (%) | 4 (0.7%) | 1 (0.2%) | 0.277 |
- Abbreviations: GA, general anesthesia; MAC, monitored anesthesia care,
| GA (n = 560) | MAC (n = 438) | p Value | |
|---|---|---|---|
| Length of hospital stay (days), median (IQR) | 3 (2–6) | 2 (2–3) | <0.001 |
| Length of intensive care unit stay (h), median (IQR) | 23.4 (20.8–26) | 23.3 (21–24) | 0.005 |
| Discharge to home, n (%) | 464 (82.9%) | 409 (93.4%) | <0.001 |
| Minor vascular complications, n (%) | 67 (13.8%) | 49 (11.2%) | 0.23 |
| Major vascular complications, n (%) | 4 (0.8%) | 2 (0.5%) | 0.487 |
| Acute kidney injury, n (%) | 83 (14.8%) | 48 (11%) | 0.073 |
| 30-day post-TAVR AR, n (%) | |||
| Mild (1+ to <2) | 140 (25%) | 75 (17.1%) | 0.003 |
| Moderate-to-severe (≥2+) | 27 (4.8%) | 8 (1.8%) | 0.011 |
| 30-day permanent pacemaker, n (%)a | 44 (10.9%) | 40 (11.1%) | 0.943 |
| Stroke/TIA (%)b | |||
| 30 days | 2% | 2.1% | 0.845 |
| 1 year | 3.2% | 3.1% | 0.922 |
| Myocardial infarction (%)b | |||
| 30 days | 0.2% | 0.2% | 0.87 |
| 1 year | 0.8% | 1.6% | 0.331 |
| Heart failure hospitalization (%)b | |||
| 30 days | 2.2% | 1.9% | 0.633 |
| 1 year | 7.9% | 9.4% | 0.624 |
| All-cause mortality (%)b | |||
| 30 days | 2.9% | 0.5% | 0.012 |
| 1 year | 14.6% | 11.7% | 0.157 |
| 3 years | 38.4% | 36.8% | 0.433 |
| MACCE (%)b | |||
| 30 days | 9.3% | 4.6% | 0.14 |
| 1 year | 21.5% | 21.1% | 0.653 |
- Abbreviations: AR, aortic regurgitation; GA, general anesthesia; MAC, monitored anesthesia care; MACCE, major adverse cardiac and cerebrovascular events (composite of stroke/transient ischemic attack, myocardial infarction, heart failure hospitalizations and all-cause death); TAVR, transcatheter aortic valve replacement; TIA, transient ischemic attack.
- a Patients with pre-existing permanent pacemakers were excluded from this analysis.
- b Cumulative Kaplan–Meier estimates.
| All-cause mortality | MACCE | |||||||
|---|---|---|---|---|---|---|---|---|
| 30 days | 3 year | 30 days | 1 year | |||||
| HR (95% CI) | p Value | HR (95% CI) | p Value | HR (95% CI) | p Value | HR (95% CI) | p Value | |
| MAC | 0.22 (0.06–0.82) | 0.024 | 0.87 (0.67–1.12) | 0.277 | 0.67 (0.39–1.15) | 0.143 | 0.86 (0.63–1.17) | 0.337 |
| Age, per 10 years | 1.34 (0.71–2.52) | 0.365 | 0.96 (0.83–1.11) | 0.605 | 1.27 (0.92–1.77) | 0.148 | 1.04 (0.88–1.24) | 0.645 |
| Male gender | 1.6 (0.53–4.88) | 0.408 | 1.5 (1.12–2) | 0.006 | 1.16 (0.65–2.09) | 0.617 | 1.65 (1.17–2.33) | 0.004 |
| STS risk score | 0.96 (0.83–1.11) | 0.586 | 1.06 (1.03–1.09) | <0.001 | 0.97 (0.9–1.05) | 0.504 | 1.03 (0.99–1.07) | 0.116 |
| KCCQ-12 overall score | 0.97 (0.95–0.99) | 0.013 | 0.99 (0.99–0.99) | 0.008 | 0.99 (0.98–0.99) | 0.024 | 0.99 (0.98–0.99) | 0.001 |
| Atrial fibrillation or flutter | 1.51 (0.5–4.58) | 0.463 | 1.51 (1.16–1.97) | 0.002 | 1.19 (0.68–2.09) | 0.537 | 1.27 (0.92–1.76) | 0.144 |
| Current dialysis | 4.42 (0.73–27) | 0.107 | 1.51 (0.86–2.65) | 0.147 | 2.09 (0.66–6.56) | 0.208 | 1.7 (0.91–3.15) | 0.094 |
| Prior MI | 0.98 (0.29–3.36) | 0.976 | 1.04 (0.78–1.39) | 0.776 | 1.49 (0.81–2.71) | 0.197 | 0.93 (0.65–1.32) | 0.663 |
| Prior CABG | 0.37 (0.08–1.8) | 0.219 | 0.59 (0.43–0.8) | 0.001 | 0.38 (0.17–0.85) | 0.018 | 0.49 (0.33–0.73) | <0.001 |
| Prior 2-week NYHA class | 0.58 (0.16–2.07) | 0.398 | 1.22 (0.89–1.68) | 0.208 | 1.03 (0.52–2.03) | 0.943 | 1.33 (0.91–1.95) | 0.138 |
| Prior 2-week heart failure | 1.07 (0.31–3.62) | 0.92 | 1.05 (0.79–1.4) | 0.75 | 0.88 (0.49–1.59) | 0.669 | 1.48 (1.01–2.16) | 0.045 |
| LVEF | 1.01 (0.96–1.06) | 0.654 | 1 (0.99–1.01) | 0.949 | 0.99 (0.97–1.02) | 0.679 | 0.99 (0.98–1.01) | 0.33 |
| LVDd | 1.39 (0.68–2.86) | 0.365 | 1.14 (0.96–1.34) | 0.139 | 0.99 (0.69–1.45) | 0.982 | 1.04 (0.84–1.27) | 0.737 |
| Moderate-to-severe MR | 1.46 (0.44–4.83) | 0.539 | 0.9 (0.67–1.2) | 0.475 | 1.07 (0.57–1.99) | 0.836 | 0.93 (0.66–1.32) | 0.68 |
| Moderate-to-severe TR | 0.44 (0.11–1.75) | 0.244 | 1.04 (0.78–1.38) | 0.799 | 0.94 (0.5–1.76) | 0.838 | 1.16 (0.83–1.63) | 0.38 |
| Nonelective TAVR | 0.8 (0.09–6.99) | 0.837 | 0.85 (0.5–1.43) | 0.535 | 0.99 (0.33–2.98) | 0.98 | 0.95 (0.53–1.69) | 0.856 |
- Abbreviations: CABG, coronary artery bypass grafting; CI, confidence interval; HR, hazard ratio; KCCQ, Kansas City Cardiomyopathy Questionnaire; LVDd, left ventricular diameter during diastole; LVEF, left ventricular ejection fraction; MACCE, major adverse cardiac and cerebrovascular events (composite of stroke/transient ischemic attack, myocardial infarction, heart failure hospitalizations and all-cause death); MR, mitral regurgitation; MI, myocardial infarction; NYHA, New York Heart Association; STS, Society of Thoracic Surgeons; TAVR, transcatheter aortic valve replacement; TR, tricuspid regurgitation.
We apologize for this error.
