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Conscious Sedation Confers Better Outcomes vs. General Anesthesia in TAVR

Article

Originally published in Healio

In This Article

  • Despite great uptake of conscious sedation in transcatheter aortic valve replacement (TAVR), there has been a lack of high-quality data comparing it with the use of general anesthesia
  • A new study from Massachusetts General Hospital found that conscious sedation in TAVR procedures improves patient outcomes when compared to general anesthesia
  • There is significant variability in the use of conscious sedation across hospitals, and effort is needed to encourage centers that primarily perform general anesthesia in TAVR to adopt conscious sedation

There is a growing interest in minimalist transcatheter aortic valve replacement (TAVR), which utilizes conscious sedation rather than general anesthesia for the procedure. This use of conscious sedation has been linked to improved outcomes in mortality, length of stay and discharge to home compared with general anesthesia, according to data presented at the American College of Cardiology Scientific Sessions by Neel M. Butala, MD, MBA, research fellow in medicine at Massachusetts General Hospital.

There have been very few studies on the choice of an anesthetic approach to TAVR. One of the few multicenter studies around this question came from data from the Society of Thoracic Surgery/American College of Cardiology Transcatheter Valve Therapeutics (TVT) registry between 2014 and 2015. The data affirmed the benefits of conscious sedation in TAVR patients, including a 37% reduction in in-hospital mortality.

Dr. Butala and colleagues used the TVT registry to analyze over 120,000 patients who underwent TAVR from 2016 to 2019. The researchers found that although the overall use of conscious sedation rose, there was significant variability in use among hospitals.

Dr. Butala says that despite the evidence for conscious sedation for TAVR, there is currently a lot of variation in the use of conscious sedation for TAVR. 17% of U.S. centers continue to exclusively use general anesthesia for TAVR procedures.

The study used instrumental variable analysis to find that conscious sedation does result in less in-hospital mortality, less 30-day mortality, shorter length of hospital stay and more frequent discharge to home when compared to general anesthesia. The researchers also found that the degree of benefit of conscious sedation compared to general anesthesia is smaller than in previous studies.

Dr. Butala estimates that if all U.S. centers used conscious sedation at the rate of the highest quartile of the TVT registry, it would result in 40 fewer deaths, 80 fewer deaths at 30 days, 12,000 fewer hospital days and cost savings of $25 million a year.

Based on this study, more effort is needed to communicate the benefits of conscious sedation for TAVR and encourage its use in the centers that currently perform TAVR primarily with general anesthesia.

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