Conscious sedation associated with better TAVR outcomes than general anesthesia
The use of conscious sedation (CS) during transcatheter aortic valve replacement (TAVR) is associated with better patient outcomes, including a decrease in mortality, than general anesthesia (GA).
A team of researchers compared the two methods, sharing its results in JACC: Cardiovascular Interventions.
“An integral component of minimalist TAVR is the use of CS instead of GA with endotracheal intubation,” wrote first author Neel M. Butala, MD, MBA, Beth Israel Deaconess Medical Center in Boston, and colleagues. “Whereas the early pivotal TAVR trials used GA exclusively, the use of CS has increased in recent years. However, robust data on the current use of CS for TAVR and its impact on clinical outcomes are lacking.”
Butala et al. tracked more than 120,000 adult patients who underwent TAVR from January 2016 to March 2019. Patient data came from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry.
Overall, the authors found that CS was associated with decreases in in-hospital mortality, 30-day mortality, shorter lengths of stay and more frequent discharges. From the start of the study to the end, CS became much more common; 33% of all TAVR procedures involved CS in January 2016, but that figure was 64% by March 2019.
Butala and colleagues emphasized that “the magnitude of absolute and relative benefit appears to be less than suggested by previous studies,” but said these improved outcomes are still significant enough to suggest CS “should be considered the preferred approach” for most patients undergoing TAVR. If U.S. facilities consistently used CS for approximately 91% of all TAVR procedures, the team estimated, it could potentially result in 36 fewer in-hospital deaths and 76 fewer deaths after 30 days.
“These results have important implications for best practices in TAVR as well as for future studies seeking to evaluate advances in the treatment of structural heart disease using large registries,” the authors added.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.