Abstract 18908: Transcutaneous Aortic Valve Replacement - 30 Day and 1 Year Outcomes Using Conscious Sedation in Patients Stratified by STS Risk Score
Introduction: Transcutaneous Aortic Valve Replacement [TAVR] is usually performed under general anesthesia [GA]. We sought to examine the feasibility and safety of monitored conscious sedation [CS] as opposed to GA .
METHODS: 196 patients [116 self expanding and 80 balloons expandable] underwent TAVR from December 2010 to August 2012 at our institution. 1 month follow up was completed on all patients and 1 year follow up was available on 105 patients. 39 patients [20%] underwent CS. Only one patient crossed over from CS to GA. We divided the patients into 3 groups [STS <8, STS of 8 to <12, STS ≥ 12 with the primary endpoints of all-cause mortality at 1 month and 1 year [See Table 1]
RESULTS: Though the study did not meet statistical significance due to low number of patients, there was a trend towards improved mortality with CS. Also, there was no statically significant difference with regards to procedural complications including periprocedural MI, major bleeding, emergency CABG or major vascular complications. All 5 patients with periprocedural stroke had GA. The CS patients had a shorter length of stay [5 +2.87 days] as compared to GA patients [8 days+7.86 days]
CONCLUSION: Use of CS suggested an improved mortality trend in higher risk patients [STS≥ 12]. This is of great importance as complications of GA, most importantly respiratory complications, are higher in the elderly TAVR patients and these can be avoided with CS . Also CS enables us to monitor neurological status during the procedure which is of vital importance given the high rates of stroke with TAVR
Author Disclosures: A. Rajamanickam: None. S. Basnet: None. K. Mucci: None. R. Rao: None. J. Yee: None. U. Baber: None. G. Dangas: None. A. Kini: None. D. Adams: None. S. Sharma: None.
- © 2014 by American Heart Association, Inc.