Comparison of clinical outcomes with the utilization of monitored anesthesia care vs. general anesthesia in patients undergoing transcatheter aortic valve replacement

Sarkis Kiramijyan, Itsik Ben-Dor, Edward Koifman, Romain Didier, Marco A. Magalhaes, Ricardo O. Escarcega, Smita I. Negi, Nevin C. Baker, Jiaxiang Gai, Rebecca Torguson, Petros Okubagzi, Federico M. Asch, Zuyue Wang, Michael A. Gaglia, Lowell F. Satler, Augusto D. Pichard, Ron Waksman*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background There is no clear consensus in regard to the optimal anesthesia utilization during transcatheter aortic valve replacement (TAVR). The aim was to compare outcomes of transfemoral (TF) TAVR under monitored anesthesia care (MAC) vs. general anesthesia (GA) and evaluate the rates and causes of intra-procedural MAC failure. Methods All consecutive patients who underwent TF TAVR from April 2007 through March 2015 were retrospectively analyzed and dichotomized into two groups: TAVR under MAC vs. GA. The main endpoints of the study included 30-day and 1-year mortality, the rates and reasons for failure of MAC, in-hospital clinical safety outcomes, and post-procedural hospital and intensive care unit length-of-stays. Results A total of 533 patients (51% male, mean-age 83 years) underwent TF TAVR under MAC (n = 467) or GA (n = 66). Fifty-six patients (12%) in the MAC group required conversion to GA. The MAC group had significantly shorter post-procedural hospital (6.0 vs. 7.9, p = 0.023) and numerically shorter ICU (2.4 vs. 2.8, p = 0.355) mean length-of-stays in days. The clinical safety outcomes were similar in both groups. Kaplan–Meier unadjusted cumulative in-hospital and 30-day mortality rates were higher in the GA group but similar in both groups at 1-year. Conclusions TF TAVR under MAC is feasible and safe, results in shorter hospital stays, can be performed in the majority of cases, and should be utilized as the default strategy. Trans-esophageal echocardiography utilization during TAVR with MAC is safe and feasible. The most common cause for conversion of MAC to GA is cardiac instability and hypotension. The complete heart team should be available at all times in case the need arises for a rapid conversion to GA.

Original languageEnglish
Pages (from-to)384-390
Number of pages7
JournalCardiovascular Revascularization Medicine
Volume17
Issue number6
DOIs
StatePublished - 1 Sep 2016
Externally publishedYes

Keywords

  • Aortic stenosis
  • General anesthesia
  • Monitored anesthesia care
  • Transcatheter aortic valve replacement

Fingerprint

Dive into the research topics of 'Comparison of clinical outcomes with the utilization of monitored anesthesia care vs. general anesthesia in patients undergoing transcatheter aortic valve replacement'. Together they form a unique fingerprint.

Cite this