Author + information
- Brett Hiendlmayr1,
- Joseph Hinchey1,
- Lauren Curtis2,
- Jeff Mather1,
- Richard Seip1,
- Marcin Dada3,
- Robert Veenstra1,
- Robert Hagberg1,
- Immad Sadiq1,
- Talhat Azemi4,
- Mohiuddin Cheema5,
- David Underhill6,
- Francis Kiernan7,
- William Duvall1,
- Raymond McKay4 and
- Alexa Clement8
- 1Hartford Hospital, Hartford, Connecticut, United States
- 2Hartford Hospital, Vernon, United States
- 3Hartford hospital, Newington, Connecticut, United States
- 4Hartford Hospital, South Glastonbury, Connecticut, United States
- 5HHC, Hartford, Connecticut, United States
- 6Hartford hospital, hartford, Connecticut, United States
- 7Hartford Hospital, hartford, Connecticut, United States
- 8University of Connecticut, Farmington, Connecticut, United States
Conscious sedation with local anesthesia (CS) has gained popularity as an alternative to traditional general anesthesia (GA) for transcatheter aortic valve replacement (TAVR) in many experienced TAVR centers. Studies comparing the two anesthetic approaches have observed shorter procedure times, decreased ICU and hospital length-of-stays (LOS), and lower procedural costs with the use of CS.
Consecutive, commercial-use TAVR patients from 2012 to 2017 at our institution were analyzed. Using propensity score analysis, transfemoral access CS patients were matched in a 1:1 fashion with GA patients to control for significant intergroup differences in baseline characteristics. Composite adverse outcomes, procedural characteristics, length of stay after TAVR, and financials were analyzed.
From a cohort of 595 patients who underwent TAVR at our institution since 2012, 94 CSA and 94 matched GA patients were analyzed. Of the CS cases reviewed, 2 cases required procedural conversion to GA. Self-expanding valves were less frequently used with CS (p<0.001). Fluoroscopy time, radiation dose, requirement for permanent pacemaker use, length of stay after TAVR, and direct cost/patient were all significantly lower with CS compared to GA, while CS contribution margin/patient was significantly higher (all p<0.01). An analysis of composite adverse events, including death, myocardial infarction, stroke, cardiac arrest, new atrial fibrillation, new dialysis, major vascular events, and unplanned vascular surgery, revealed that GA patients were 2.2 times more likely to experience a major event than matched CS cohorts. (95% confidence interval: 1.09-4.32; p<0.03).
Conscious sedation TAVR patients are 2.2 times less likely to experience a major perioperative event compared with patients that undergo general anesthesia with respect to a composite of death, myocardial infarction, stroke, cardiac arrest, new atrial fibrillation, new dialysis, major vascular event, and unplanned vascular surgery. In addition, CS is associated with decreased fluoroscopy time and radiation exposure, decreased LOS after TAVR and improved hospital reimbursement.
STRUCTURAL: Valvular Disease: Aortic