Cardiorespiratory Stability of Patients Undergoing Transcatheter Aortic Valve Replacement Is Not Improved During General Anesthesia Compared to Sedation: A Retrospective, Observational Study

Abstract

ABSTRACTPurpose: To evaluate whether general anesthesia (GA) provides improved cardiorespiratory stability compared to sedation during TAVR.Methods: A retrospective analysis at a single center, university hospital. Patients undergoing TAVR were given either routine GA or deep sedation with dexmedetomidine for TAVR.Results: The superiority of GA versus deep sedation was evaluated statistically by testing if any of the following were lower in the GA patient group; the incidence of cardiorespiratory perturbations (hypotension, bradycardia, or hypoxemia), the amount of volume resuscitation (crystalloid, colloid, or allogeneic blood administration), or the doses of drugs needed to control blood pressure (epinephrine, norepinephrine, calcium, and nitroglycerine). A total of 206 TAVR patients were studied. Of these, 150 patients underwent TAVR via the transfemoral approach and were included for comparative analysis. In total 58 (39%) received sedation. Sedation patients were older than those who received GA. There were not less cardiorespiratory perturbations in the GA group. No less vasocactive agents were administered in the GA patients. Volume resuscitation was also not less in the patients receiving GA. All broad indices of stability were not lower in GA patients. Patients in the GA group were also more likely to receive a packed red blood cell transfusion. In all, 8 (13.8%) of the patients required conversion of sedation to GA. Patients who received GA were almost twice as likely to be transferred to the ICU intubated.Conclusion: Transfemoral TAVR patients who received GA did not have more cardiorespiratory stability compared to those receiving sedation.