ACC House Call: Conscious Sedation for TAVR Procedure

In a first-of-its-kind assessment of transfemoral transcatheter aortic valve replacement (TAVR) conducted with conscious sedation versus general anesthesia, investigators found significant variations of use for either practice.

They also found, however, better outcomes with patients to have undergone conscious sedation compared to general anesthesia.

The study, led by Neel Butala, MD, MBA, of Massachusetts General Hospital, showed overall conscious sedation use in TAVR procedures logged in the STC/ACC TVT Registry increased from one-third to nearly two-thirds of all instances from January 2016 to March 2019.

Their findings also showed patients receiving conscious sedation with TAVR fared better in in-hospital mortality, mean length of hospital stay, use of inotropic drugs, and overall home discharge rates compared to general anesthesia.

The results, planned for presentation at the ACC.20 Together with Word Congress of Cardiology (ACC/WCC) Scientific Sessions this year, could influence national guidance on TAVR practice—at a time when the practice is being refined and considered for lower-risk eligible patients.

In an interview with HCPLive® on the eve of the virtual conference, corresponding study author David Cohen, MD, MSc, professor of Medicine at the University of Missouri-Kansas City, detailed his team’s findings, the reasons for varied sedation/anesthesia use in TAVR procedure, and what could come of understanding conscious sedation’s clinical benefits.

“My hope is this information, first of all, will embolden the sites already doing conscious sedation,” Cohen said. “But I also hope this information can bring along the sites that are doing it almost never, to start ramping up.”

The study, “Conscious Sedation Versus General Anesthesia for Transcatheter Aortic Valve Replacement: Results of an Instrumental Variable Analysis,” was published online in JACC.