The use of conscious sedation for TAVR may be associated with improved outcomes compared with general anesthesia, according to results of a study presented during ACC.20/WCC and simultaneously published March 16 in JACC: Cardiovascular Interventions.

Using data from the STS/ACC TVT Registry, Neel M. Butala, MD, MBA, et al., looked at the relationship between conscious sedation vs. general anesthesia and TAVR outcomes based on hospital proportion of conscious sedation use. The researchers also examined variations in the use of conscious sedation for TAVR across hospitals and over time. The primary outcome was in-hospital mortality. Secondary outcomes included 30-day mortality, procedural success, hospital length of stay, use of inotropic drugs and discharge home.

The final sample included 120,080 patients from 559 sites who underwent TAVR between 2016 and 2019. In adjusted analyses, in-hospital mortality was 1.1% among TAVR patients receiving conscious sedation vs. 1.3% among those receiving general anesthesia. In addition, conscious sedation was associated with lower 30-day mortality, shorter hospital stays, less use of inotropic drugs and more frequent discharge home. There was no difference in procedural success between conscious sedation and general anesthesia. 

The proportion of sites using conscious sedation increased from 50% to 76% during the study period, while the proportion of TAVR procedures performed with conscious sedation increased from 33% to 63%. There was wide variation in use of conscious sedation across hospitals. In the final 12 months of the study, 43% of sites performed more than 80% of TAVR cases with conscious sedation, while 17% of sites performed no cases with conscious sedation.

According to the researchers, use of conscious sedation for TAVR has increased, although substantial hospital-level variations remain. The study suggests that conscious sedation for TAVR is associated with improved outcomes compared with general anesthesia, they note. Conscious sedation “should be considered the preferred approach to anesthesia for the vast majority of patients undergoing TAVR,” they conclude.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention

Keywords: acc20, acc20, ACC Annual Scientific Session, National Cardiovascular Data Registries, STS/ACC TVT Registry, Hospital Mortality, Conscious Sedation, Patient Discharge, Transcatheter Aortic Valve Replacement, Anesthesia, General, Registries

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