Use of Moderate Sedation During TAVR Linked to Better Outcomes
Use of moderate sedation during minimally invasive transfemoral transcatheter aortic valve replacement (TAVR) leads to better clinical outcomes than those achieved with general anesthesia, report researchers from the Perelman School of Medicine, University of Pennsylvania in the largest observational study to look at moderate sedation in this setting.
Jay Giri, MD, Assistant Professor of Cardiovascular Medicine, presented the study’s findings at the Society for Cardiovascular Angiography and Interventions 2016 Scientific Sessions.
Now considered the preferred therapy for severe aortic stenosis in patients at high risk for open-heart surgery, TAVR is increasingly performed on patients under moderate sedation as researchers continue to look for ways to improve the procedure.
“Since there is no longer a definitive need for surgical inclusion, we had to ask the question of whether there was a need for general anesthesia,” said Dr Giri.
To determine whether the use of moderate sedation during TAVR improves patient outcomes compared with general anesthesia, Giri and colleagues used data from the STS/ACC TVT Registry to assess outcomes of patients undergoing elective TAVR from April 2014 through June 2015. The registry includes all patients who undergo TAVR in the US, as well as those who elect for therapy via the percutaneous transfemoral approach.
Of the 10,997 patients identified who underwent TAVR during the study period, 1,737 (15.8%) received moderate sedation.
Compared with patients who received general anesthesia, those who received moderate sedation had lower rates of 30-day mortality (4.08 vs 2.92; P = .03), 30-day mortality or stroke (6.4% vs 4.8%; P = .01), and briefer hospital stays (6.7 vs 6.0 days; P < .0001).
These improved outcomes with moderate sedation were further confirmed by a propensity-matched analysis the investigators conducted that accounted for 51 factors know to predict 30-day TAVR mortality (eg, age, gender, and heart failure status).
“While it is nearly impossible to account for all factors that could lead to needing general anesthesia, the 51 comorbidities and clinical characteristics we were able to account for still brought us to the same outcome – moderate sedation is associated with better clinical outcomes for patients undergoing percutaneous transfemoral TAVR,” said Dr Giri.
Giri J, et al. Moderate vs General Anesthesia for Transcatheter Aortic Valve Replacement: An STS/ACC Transcatheter Valve Therapy Registry Analysis.” Presented at the Society for Cardiovascular Angiography and Interventions (SCAI) 2016 Scientific Sessions. May 6, 2016. Orlando, FL.
