Comparison of Conscious Sedation Versus General Anesthesia for TAVR

Transcatheter aortic valve replacement (TAVR) with conscious sedation is associated with lower in-hospital and 30-day mortality and a shorter length of stay compared to TAVR with general anesthesia, according to a recent study published in Circulation.  

Matthew C. Hyman, MD, PhD, et al., used the STS/ACC TVT Registry to analyze the outcomes of 10,997 patients at 314 hospitals who underwent elective percutaneous transfermoral TAVR between April 1, 2014 and June 30, 2015. Approximately 15.8 percent (n=10,997) were treated with conscious sedation, of whom 102 converted from conscious sedation to general anesthesia. Over the study period, the percentage of national TAVR cases performed under conscious sedation per quarter rose 9 percentage points (11 percent to 20 percent, p<0.001), as did the number of sites utilizing conscious sedation for at least one TAVR case.

While intraprocedural success was similar, those who underwent TAVR with conscious sedation were less likely to suffer in-hospital (1.6 percent vs. 2.5 percent, p=0.03) and 30-day (2.9 percent vs. 4.1 percent, p=0.03) death than those treated with general anesthesia. Additionally, further analysis showed conscious sedation patients had a briefer ICU and hospital length of stay than general anesthesia patients. They were also more likely to be discharged directly home.

The study authors note that the results “have the potential to alter the current standard of care for TAVR,” since the transition to conscious sedation “may allow TAVR cases to move from operating rooms to catheterization laboratories and improve post-procedurally recovery times.”

“The most important finding of this study is the observation that TAVR with conscious sedation can be performed safely,” they add. The data showed an adjusted lower procedural success rate of 97.9 percent, a minimal difference compared to the general anesthesia group (98.6 percent).

Researchers find these results to be “even more notable as the current study evaluated utilization of conscious sedation during its initial entry into US practice, and the outcomes for conscious sedation may improve as centers gain more experience.” Given the 30-day event rates observed in this study, the authors suggest a randomized trial with 4,776 patients to establish the superiority of one technique over the other. 

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention

Keywords: Conscious Sedation, Operating Rooms, Transcatheter Aortic Valve Replacement, Research Personnel, Length of Stay, Standard of Care, Anesthesia, General, Patient Discharge, Hospitals, Registries, Catheterization, Intensive Care Units

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