Abstract 12876: Impact of Anesthesia Type on Short- and Long-term Outcomes After Transcatheter Aortic Valve Replacement: The Cleveland Clinic Experience

Abstract

Introduction: The early approach was to perform transcatheter aortic valve replacement (TAVR) under general anesthesia (GA). Over time, monitored anesthesia care (MAC) has been introduced as a less invasive option to facilitate TAVR. Objective: We sought to compare short- and long-term outcomes between TAVR patients undergoing GA versus those receiving MAC. Methods: We identified all consecutive patients with severe symptomatic aortic stenosis who underwent Transfemoral (TF)-TAVR at our institution between January 2012 and April 2017. Results: We included 998 patients who met our inclusion criteria. Overall, the mean age was 80.4 ± 9.7 years, 57.4% were males and 95.2% were Caucasians. MAC was used in 43.9%. The mean STS risk score (SD) was lower with MAC (6.7 ± 4.3% vs. 7.6 ± 4.5%; p = 0.004). MAC was associated with lower all-cause mortality at both 30 days (0.5% vs. 4.2%; log-rank p < 0.001), and 1 year (11.7% vs. 16%; log-rank p = 0.024). However, this difference was negated at 3 years (37% vs. 39%; log-rank p = 0.271). Further, there were no differences in major adverse cardiac and cerebrovascular events (MACCE) at either 30 days (4.6% vs. 7.6%; log-rank p = 0.089) or 1 year (21.5% vs. 24.2%; log-rank p = 0.242). There were no differences in the rates of myocardial infarction (1.6% vs. 0.9%; log-rank p = 0.375), stroke or transient ischemic attacks (3.1% vs. 3.4%; log-rank p = 0.817) or heart failure hospitalizations (9.6% vs. 9.5%; log-rank p = 0.815) at 1 year. In multivariate analysis, MAC predicted lower all-cause death at 1 year after TAVR (HR 0.672; 95% CI 0.453 - 0.996; p = 0.048) but not at 3 years (HR 0.882 (0.705 - 1.103; p = 0.271). MAC was not an independent predictor of MACCE (HR 0.851; 95% CI 0.643 - 1.126; p = 0.258). Conclusions: Compared to GA, MAC was associated with lower all-cause mortality at both 30 days and 1 year, but not at 3 years. There were no differences in MACCE between the two groups at either 30 days or 1 year.