Safety and Outcomes of Transesophageal Echocardiography Guided TAVR Using Moderate Sedation

Tuesday, May 21, 2019
Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)
Mandeep S Randhawa, MD , Michigan State University, East Lansing, MI
Yehia Saleh, MD , Michigan State University, East Lansing, MI
Khader Herzallah, MD , Michigan State University, East Lansing, MI
Phani Surapaneni, MD , Michigan State University, East Lansing, MI
Amritpal K Randhawa, MBBS , Michigan State University, East Lansing, MI
Miriam Glardon, RN , Sparrow Clinical Research Institute, Lansing, MI
Gaurav Dhar, MD , Thoracic and Cardiovascular Institute, Okemos, MI

Background:
Transesophageal echocardiography (TEE) guided TAVR have shown better procedural outcomes. In some centers, the routine use of TEE during TAVR is discouraged due to the supposed requirement of the general anesthesia. We look for the outcomes in patients who underwent TEE-guided TAVR using only moderate sedation.

Methods:
250 patients underwent TEE-guided TAVR. The data was analyzed from registry comparing the procedure length, in-hospital stay, major complications; immediate and 1-month all cause-mortality and mean trans-aortic gradient of the patients underwent TEE-guided TAVR using moderate sedation compared to general anesthesia.

Results:
Of 250 procedures 131 (52.4%) the under moderate sedation, the average age was 81±8.6 with 71 (54.2%) males. They had STS score of 7.9±4.7 and KCCQ score of 39.5±21. Similarly, 116 (46.4%) procedures were under general anesthesia, the average age was 82±8.6 with 59 (50.9%) males; STS score 8.35±3.8 (p=0.43) and KCCQ score of 37.7±24 (p= 0.56). In 3 patients, moderate sedition was converted to general anesthesia during the procedure. Patients under moderate sedation stayed in-hospital post-TAVR for 2.72±2.4 days; duration of procedure was 144±29 minutes, in-hospital mortality was 4 (3%); stroke was 4 (3%); atrial fib/flutter was recorded in 3 (2.3%) patients; mean trans-aortic gradient at 1-month was 10.5±4.8 mmHg and 1-month mortality was 4/125 (3%). Whereas, patients under general anesthesia, the in-hospital stay was 4.61±4 days (p=<0.05); duration of procedure was 178±38 minutes (p=<0.05); in-hospital mortality was 5 (4.3%, p=0.6); stroke were 3 (2.6%, p=0.83); atrial fib/flutter was recorded in 5 (4.3%, p=0.38) patients; mean trans-aortic gradient at 1-month was 11.8±71 mmHg, (p=0.12) and 1- month mortality was 3/98 (2.6%, p=0.95).

Conclusions:
Use of TEE with moderate sedation during TAVR, is safe and significantly reduces the duration of the procedure and in-hospital length of stay with similar procedural success, as with general anesthesia.

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