• J. Cardiothorac. Vasc. Anesth. · Sep 2021

    Comparative Study

    Comparison of Deep Sedation and General Anesthesia With an Endotracheal Tube for Transcaval Transcatheter Aortic Valve Replacement: A Pioneering Institution's Experience.

    • Joseph A Sanders, Ashwin Vaidyanathan, Huma Sayeed, Bhumika Sherdiwala, Xiaoxia Han, Janet Wyman, Dee Dee Wang, and William O'Neill.
    • Department of Anesthesiology, Henry Ford Hospital, Detroit, MI. Electronic address: Jsande11@hfhs.org.
    • J. Cardiothorac. Vasc. Anesth. 2021 Sep 1; 35 (9): 2607-2612.

    ObjectivesTranscaval transcatheter aortic valve replacement (TC-TAVR) is an alternative approach to transcatheter aortic valve replacement involving deployment of the bioprosthetic valve via a conduit created from the inferior vena cava to the descending aorta in patients for whom the traditional transfemoral approach is not feasible. By analyzing the largest known cohort of TC-TAVR patients, the authors wished to compare hospital length of stay and post-procedure outcomes between patients who underwent the procedure under deep sedation (DS) and patients who underwent general anesthesia with an endotracheal tube.DesignRetrospective, single-center study.SettingHenry Ford Hospital in Detroit, MI.ParticipantsPatients undergoing TC-TAVR from 2015 to 2018.Measurements And Main ResultsSeventy-nine patients were included in the analysis, which consisted of 38 under general anesthesia with an endotracheal tube and 41 under DS. The sample was divided into a general anesthesia (GA) group and DS group. There were no significant differences in implant success rate or post-procedure outcomes, including in-hospital mortality (p = 0.999) and major vascular complication rate (p = 0.481), between the two groups. Patients in the GA group stayed a median of 24 hours longer in the intensive care unit (ICU) (p < 0.001) and one day longer in the hospital (p = 0.046) after the procedure compared to patients in the DS group. The median procedure time was significantly lower (135 minutes) in the DS group compared to the GA group (167 minutes, p < 0.001).ConclusionsPatients undergoing TC-TAVR under DS had similar postoperative outcomes and shorter post-procedure hospital and ICU lengths of stay compared to general anesthesia. In the authors' experience, DS is the preferred anesthetic technique for TC-TAVR.Copyright © 2020 Elsevier Inc. All rights reserved.

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