Conscious Sedation vs. General Anesthesia for Transcatheter Aortic Valve Replacement: A Retrospective Analysis

Background:
Conscious sedation (CS), allowing patient to stay awake during procedure, is increasingly utilized as a minimally invasive technique during transcatheter aortic valve replacement (TAVR). Whether this approach improves clinical outcomes in comparison to general anesthesia (GA) is a topic of discussion. We report from our 5-year experience at a large tertiary care referral center.

Methods:
It is a retrospective analysis of all patients undergoing TAVR at our center from December 2012 to April 2018. A heart-valve team determined whether patients received CS or GA. Data were extracted from hospital electronic medical record. Patients were excluded if they had procedure aborted, required surgical conversion, or were complicated by cardiopulmonary bypass. Student’s t-test and Chi square test were used to compare baseline characteristics. Adjusted linear and logistic regression were used for clinical outcomes. Primary outcomes were intensive care unit monitoring (ICU hours) and hospital length-of-stay (LOS).

Results:
After exclusion, final sample size was 418 (Mean age: 80.5± 8.5; 51% Male). 194 patients (47%) received CS and 224 patients (53%) received GA. Compared with patients in the GA group, CS patients were younger (80.8 vs 81.8, p=0.033), had lower STS scores (5.7 vs 8.4, p<0.001) and lower incidence of heart failure 2 weeks prior to procedure (11.3 vs 44.6, p<0.001). Patients in the CS group required significantly shorter ICU stay (31.5 hours vs 41.6 hours, p<0.001) and LOS (2.9 days vs 3.8 days, p=0.01).

Conclusions:
Use of conscious sedation during TAVR significantly reduces ICU hours and LOS compared with general anesthesia.