Abstract 19710: Comparison of Clinical Outcomes With the Utilization of Monitored vs. General Anesthesia in Patients Undergoing Transcatheter Aortic Valve Replacement

Abstract

Introduction: There is no clear consensus in regard to the optimal anesthesia utilization in TAVR. The objective of this study was to contribute to the observational literature in evaluating the impact of monitored anesthesia care (MAC) vs. General Anesthesia (GA) in TAVR. Hypothesis: No difference in short- or long-term mortality in patients undergoing TAVR with MAC vs. GA. Methods: All consecutive patients who underwent transfemoral TAVR from May 2007 through March 2015 at the MedStar Washington Hospital Center had prospectively collected data and were retrospectively analyzed for this study. Furthermore, the cohort was dichotomized into two groups: TAVR under MAC vs. GA as planned method of anesthesia. The primary endpoints included 30-days and 1-year mortality outcomes. The secondary endpoints included: all in-hospital VARC-2 safety outcomes, mean post-procedural hospital and ICU stays, and reasons and rates for intra-procedural conversion of MAC to GA. Results: A total of N=533 consecutive patients (51% male, mean-age 83 years) who underwent TAVR under MAC (n=467) vs. GA (n=66) were evaluated. Significant baseline, procedural and in-hospital outcomes are depicted in the figure. 12% of the MAC patients required conversion to general anesthesia (figure). The MAC group had shorter post-procedural hospital (6 vs. 7.9, p=0.023) and similar ICU (2.4 vs. 2.8, p=0.355) length of stays in days vs. the GA group, respectively. The 30-days and 1-year mortality outcomes were similar between the two groups (figure). Conclusions: TAVR under controlled monitored anesthesia is feasible and safe, and can be performed in the majority of cases, therefore avoiding the need for general anesthesia and resulting in shorter post-procedural hospital stays. Most common cause for conversion of MAC to GA is cardiac instability and hypotension. TAVR procedures should be planned with MAC as the default strategy for anesthesia.