• N Patrick Mayr, Costanza Pellegrini, Tobias Rheude, Teresa Trenkwalder, Hector A Alvarez-Covarrubias, Erion Xhepa, Pieter van der Starre, Gunther Wiesner, Heribert Schunkert, Peter Tassani-Prell, and Michael Joner.
• Institut für Anästhesiologie, Deutsches Herzzentrum München, Technische Universität München, Germany. Electronic address: patrick.mayr@tum.de.
• Am. J. Cardiol. 2020 Jul 15; 127: 99-104.

AbstractTransfemoral Transcatheter Aortic Valve Implantation (tf-TAVI) has become an established therapy-option for patients with symptomatic severe aortic stenosis. Conscious sedation (CS) has proven to be an alternative to general anesthesia . So far, the outcome of patients undergoing unplanned periprocedural conversion from CS to general anesthesia has not been investigated. All patients undergoing transfemoral transcatheter aortic valve implantation in CS between 2014 and 2019 were included. The primary end point was early safety at 30 days according to Valve Academic Research Consortium-2 criteria. The reasons for conversion and length of ICU-/ hospital stay were further analyzed. Of 1,058 included patients 35 (3.3%) required a conversion. The end point was documented in 13 (37%) of the converted and 110 (11%) of nonconverted patients (p < 0.001). The causes were: unrest in 11/35 patients, procedural complications in 10/35 patients, respiratory distress in 8/35, and cardiovascular decompensation in 6 patients (17.1%). Compared with the group without conversion (Median (interquartile range ), 4 [4-5] days), length of hospital stay was longest in the group with procedural complications (6 [1-11] days) followed by cardiovascular decompensation (5 [4-7] days). In conclusion, the conversion rate to general anesthesia was low in a large cohort of unselected transcatheter aortic valve implantation patients. Additionally, hospital stay was longer dependent on the reason for conversion.Copyright © 2020 Elsevier Inc. All rights reserved.

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