Comparison of Monitored Anesthesia Care and General Anesthesia for Transcatheter Aortic Valve Replacement

Research output: Contribution to journalArticle

Abstract

Objective: Transcatheter aortic valve replacement is a safe, minimally invasive treatment for severe aortic stenosis in patients with moderate-to-high surgical risk. Monitored anesthesia is administered by an anesthesiologist. This study compares transcatheter aortic valve outcomes under monitored anesthesia vs general anesthesia. Methods: Data were prospectively collected for 286 patients undergoing transcatheter aortic valve replacement at a single academic hospital from March 2012 to August 2016. The patients were grouped by type of anesthesia: monitored vs general. A propensity score match was performed to compare intraoperative and post-operative outcomes between groups. Results: General anesthesia was used in 102 patients and moderate sedation in 184. Propensity score matching produced 80 pairs. Compared to procedures under general anesthesia, patients receiving monitored anesthesia had shorter procedure (1.6 [1.4, 2.0] vs 2.0 [1.6, 2.5] hours;P < 0.001) and fluoroscopy times (17 [14.5, 22.5] vs 25 [17.9, 30.3] minutes;P < 0.001) and shorter hospital length-of-stay (3 [2.0, 4.0] vs 5 [3.0, 7.0] days;P < 0.001) but no difference in intensive care unit length-of-stay. Blood transfusion was more common in patients undergoing general anesthesia, but there was no difference in stroke, renal failure, postoperative atrial fibrillation, or need for permanent pacemaker. More patients were discharged to home after monitored anesthesia (90% vs 64%;P < 0.001). There was no difference in 30-day mortality (0% vs 3%;P = 0.15). Conclusions: Transcatheter aortic valve replacement under monitored anesthesia provides the safety of anesthesia-led sedation without intubation and general anesthetic. We found no compromise in patient safety or clinical outcomes.

Original languageEnglish (US)
Pages (from-to)436-444
Number of pages9
JournalInnovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Volume14
Issue number5
DOIs
StatePublished - Oct 1 2019

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General Anesthesia
Anesthesia
Length of Stay
Propensity Score
Conscious Sedation
General Anesthetics
Fluoroscopy
Aortic Valve Stenosis
Patient Safety
Transcatheter Aortic Valve Replacement
Aortic Valve
Intubation
Blood Transfusion
Atrial Fibrillation
Renal Insufficiency
Intensive Care Units
Stroke
Safety
Mortality

Keywords

  • aortic valve
  • monitored anesthesia care
  • transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

@article{a42226546c7f483696efeb1e50800062,
title = "Comparison of Monitored Anesthesia Care and General Anesthesia for Transcatheter Aortic Valve Replacement",
abstract = "Objective: Transcatheter aortic valve replacement is a safe, minimally invasive treatment for severe aortic stenosis in patients with moderate-to-high surgical risk. Monitored anesthesia is administered by an anesthesiologist. This study compares transcatheter aortic valve outcomes under monitored anesthesia vs general anesthesia. Methods: Data were prospectively collected for 286 patients undergoing transcatheter aortic valve replacement at a single academic hospital from March 2012 to August 2016. The patients were grouped by type of anesthesia: monitored vs general. A propensity score match was performed to compare intraoperative and post-operative outcomes between groups. Results: General anesthesia was used in 102 patients and moderate sedation in 184. Propensity score matching produced 80 pairs. Compared to procedures under general anesthesia, patients receiving monitored anesthesia had shorter procedure (1.6 [1.4, 2.0] vs 2.0 [1.6, 2.5] hours;P < 0.001) and fluoroscopy times (17 [14.5, 22.5] vs 25 [17.9, 30.3] minutes;P < 0.001) and shorter hospital length-of-stay (3 [2.0, 4.0] vs 5 [3.0, 7.0] days;P < 0.001) but no difference in intensive care unit length-of-stay. Blood transfusion was more common in patients undergoing general anesthesia, but there was no difference in stroke, renal failure, postoperative atrial fibrillation, or need for permanent pacemaker. More patients were discharged to home after monitored anesthesia (90{\%} vs 64{\%};P < 0.001). There was no difference in 30-day mortality (0{\%} vs 3{\%};P = 0.15). Conclusions: Transcatheter aortic valve replacement under monitored anesthesia provides the safety of anesthesia-led sedation without intubation and general anesthetic. We found no compromise in patient safety or clinical outcomes.",
keywords = "aortic valve, monitored anesthesia care, transcatheter aortic valve replacement",
author = "Kislitsina, {Olga N.} and Danielle Smith and Sherwani, {Saadia S.} and Pham, {Duc Thinh} and Andrei Churyla and Ricciardi, {Mark J.} and Davidson, {Charles J.} and Flaherty, {James D.} and Sweis, {Ranya N.} and Jane Kruse and Andrei, {Adin Chistian} and McCarthy, {Patrick M.} and {Chris Malaisrie}, S.",
year = "2019",
month = "10",
day = "1",
doi = "10.1177/1556984519872463",
language = "English (US)",
volume = "14",
pages = "436--444",
journal = "Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery",
issn = "1556-9845",
publisher = "Lippincott Williams and Wilkins",
number = "5",

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TY - JOUR

T1 - Comparison of Monitored Anesthesia Care and General Anesthesia for Transcatheter Aortic Valve Replacement

AU - Kislitsina, Olga N.

AU - Smith, Danielle

AU - Sherwani, Saadia S.

AU - Pham, Duc Thinh

AU - Churyla, Andrei

AU - Ricciardi, Mark J.

AU - Davidson, Charles J.

AU - Flaherty, James D.

AU - Sweis, Ranya N.

AU - Kruse, Jane

AU - Andrei, Adin Chistian

AU - McCarthy, Patrick M.

AU - Chris Malaisrie, S.

PY - 2019/10/1

Y1 - 2019/10/1

N2 - Objective: Transcatheter aortic valve replacement is a safe, minimally invasive treatment for severe aortic stenosis in patients with moderate-to-high surgical risk. Monitored anesthesia is administered by an anesthesiologist. This study compares transcatheter aortic valve outcomes under monitored anesthesia vs general anesthesia. Methods: Data were prospectively collected for 286 patients undergoing transcatheter aortic valve replacement at a single academic hospital from March 2012 to August 2016. The patients were grouped by type of anesthesia: monitored vs general. A propensity score match was performed to compare intraoperative and post-operative outcomes between groups. Results: General anesthesia was used in 102 patients and moderate sedation in 184. Propensity score matching produced 80 pairs. Compared to procedures under general anesthesia, patients receiving monitored anesthesia had shorter procedure (1.6 [1.4, 2.0] vs 2.0 [1.6, 2.5] hours;P < 0.001) and fluoroscopy times (17 [14.5, 22.5] vs 25 [17.9, 30.3] minutes;P < 0.001) and shorter hospital length-of-stay (3 [2.0, 4.0] vs 5 [3.0, 7.0] days;P < 0.001) but no difference in intensive care unit length-of-stay. Blood transfusion was more common in patients undergoing general anesthesia, but there was no difference in stroke, renal failure, postoperative atrial fibrillation, or need for permanent pacemaker. More patients were discharged to home after monitored anesthesia (90% vs 64%;P < 0.001). There was no difference in 30-day mortality (0% vs 3%;P = 0.15). Conclusions: Transcatheter aortic valve replacement under monitored anesthesia provides the safety of anesthesia-led sedation without intubation and general anesthetic. We found no compromise in patient safety or clinical outcomes.

AB - Objective: Transcatheter aortic valve replacement is a safe, minimally invasive treatment for severe aortic stenosis in patients with moderate-to-high surgical risk. Monitored anesthesia is administered by an anesthesiologist. This study compares transcatheter aortic valve outcomes under monitored anesthesia vs general anesthesia. Methods: Data were prospectively collected for 286 patients undergoing transcatheter aortic valve replacement at a single academic hospital from March 2012 to August 2016. The patients were grouped by type of anesthesia: monitored vs general. A propensity score match was performed to compare intraoperative and post-operative outcomes between groups. Results: General anesthesia was used in 102 patients and moderate sedation in 184. Propensity score matching produced 80 pairs. Compared to procedures under general anesthesia, patients receiving monitored anesthesia had shorter procedure (1.6 [1.4, 2.0] vs 2.0 [1.6, 2.5] hours;P < 0.001) and fluoroscopy times (17 [14.5, 22.5] vs 25 [17.9, 30.3] minutes;P < 0.001) and shorter hospital length-of-stay (3 [2.0, 4.0] vs 5 [3.0, 7.0] days;P < 0.001) but no difference in intensive care unit length-of-stay. Blood transfusion was more common in patients undergoing general anesthesia, but there was no difference in stroke, renal failure, postoperative atrial fibrillation, or need for permanent pacemaker. More patients were discharged to home after monitored anesthesia (90% vs 64%;P < 0.001). There was no difference in 30-day mortality (0% vs 3%;P = 0.15). Conclusions: Transcatheter aortic valve replacement under monitored anesthesia provides the safety of anesthesia-led sedation without intubation and general anesthetic. We found no compromise in patient safety or clinical outcomes.

KW - aortic valve

KW - monitored anesthesia care

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