Minimalist TAVR to the Max

Transcatheter aortic valve replacement (TAVR) is increasingly being performed under conscious sedation, which is associated with a multi-point benefit (including mortality). 

This paper, recently published in JACC Intv., shows that general anesthesia is becoming obsolete, although the magnitude the benefit derived from conscious sedation appears to be lower than in previous studies.

The aim of this study was to examine variation in the use of conscious sedation for transcatheter aortic valve replacement across hospitals and over time. Another aim was to detect signs showing the impact (if any) of this type of anesthesia on outcomes, compared with general anesthesia.

The study included 120,080 patients in the Transcatheter Valve Therapy (TVT) Registry who underwent transfemoral transcatheter aortic valve replacement between 2016 and 2019.

Over the study period, the use of conscious sedation increased from 33% to 64% in the general population. There was a great dispersion among sites, ranging from 0% to 91% of cases.

Read also: Virtual ACC 2020 | Conscious Sedation in TAVR.

Conscious sedation was associated with decreased in-hospital mortality and 30-day mortality, shorter hospitalization time, and more frequent discharge to home (instead of a rehabilitation center, for example), compared with general anesthesia.

However, the magnitude of the benefit derived was lower than in previous studies using a propensity score–based approach to compare populations.

Conclusion

The use of conscious sedation for transcatheter aortic valve replacement continues to increase in order to minimize and simplify our procedures, although there remains wide variation across hospitals and professionals. The multiple derived benefits observed in this study, compared with general anesthesia, were less than in previous studies.

Original Title: Conscious Sedation Versus General Anesthesia for Transcatheter Aortic Valve Replacement. Variation in Practice and Outcomes.

Reference: Neel M. Butala et al. J Am Coll Cardiol Intv 2020;13:1277–87. https://doi.org/10.1016/j.jcin.2020.03.008.

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