The Perks of Conscious Sedation in TAVR

The main advantage of transcatheter aortic valve replacement (TAVR) has always been its less invasive nature, compared against surgery. Many of the advances in this technique revolve around making it even less invasive, increasing the gap between the two. The kind of anesthesia has been one of these many advances.

Ventajas de la sedación consciente en el TAVI

There are several reports (in general from one single center) describing TAVR experiences using only local anesthesia and conscious sedation, in contrast with the first randomized studies, which nearly always used general anesthesia.


Read also: Role of general anesthesia compare to conscious sedation during TAVR”.


This study used the registry NCDR STS/ACC TVT to characterize the choice of anesthesia and clinical outcomes of all patients undergoing transfemoral TAVR between April 2014 and June 2015 in the US.

 

Conscious sedation was used in 1737 of 10997 patients included in the registry (15.8%), with a clear trend towards increased use over time. The group that used conscious sedation had lower in-hospital mortality (1.6% vs 2.5%; p=0.03), and at 30 days (2.9% vs. 4.1%, p=0.03). 5.9% of patients required conversion to general anesthesia.

 

Even though the benefit in terms of short-term mortality was clear, so was the lower procedural success rate (97.9% vs. 98.6%; p<0.001).


Read also: Conscious Sedation in TAVR: Is It Advisable?”


Conscious sedation was also associated to ‘softer’ end points, such as lower inotropics requirement, shorter critical care stay, and shorter hospital stay.

 

Conclusion

Conscious sedation reduced hospital stay and mortality at short term, compared to TAVR patients under general anesthesia. These results suggest it is safe  to use this technique to treat the high risk population.

 

Editorial Comment

The lower technical success rate might be the consequence of not using control transesophageal echocardiography during implantation in patients using conscious sedation. The use of angiography or transthoracic echocardiography in this group might have compromised accuracy, and therefore increased paravalvular leak.

 

Original title: Conscious Sedation versus General Anesthesia for Transcatheter Aortic Valve Replacement: Insights from the NCDR® STS/ACC TVT Registry.

Reference: Hyman et al. Circulation. 2017 Sep 1. Epub ahead of print.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.

More articles by this author

TCT 2024 | TRISCEND II

This randomized study included 400 patients; 267 were treated with EVOQUE valve and 133 with optimal medical treatment (OMT). After one-year follow-up, there were no...

TCT 2024 – ACCESS-TAVI: Comparing Percutaneous Access Closure Strategies After TAVI

Vascular access complications following transcatheter aortic valve implantation (TAVI) remain common. However, few studies compare vascular access closure methods.  Based on the CHOICE-CLOSURE and MASH...

TAVR in Young Low-Risk Patients

Transcatheter aortic valve replacement (TAVR) has established itself as an effective strategy for the treatment of severe aortic stenosis across different risk groups. While previous...

TAVR and Atrial Fibrillation: What Anticoagulants Should We Use?

The prevalence of atrial fibrillation (AF) in TAVR patients ranges from 15 to 30%, depending on series. This arrhythmia has been associated to higher...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

TCT 2024 | FAVOR III EUROPA

The study FAVOR III EUROPA, a randomized trial, included 2,000 patients with chronic coronary syndrome, or stabilized acute coronary syndrome, and intermediate lesions. 1,008...

TCT 2024 | TRISCEND II

This randomized study included 400 patients; 267 were treated with EVOQUE valve and 133 with optimal medical treatment (OMT). After one-year follow-up, there were no...

TCT 2024 – ACCESS-TAVI: Comparing Percutaneous Access Closure Strategies After TAVI

Vascular access complications following transcatheter aortic valve implantation (TAVI) remain common. However, few studies compare vascular access closure methods.  Based on the CHOICE-CLOSURE and MASH...