• Saroj Pani, John Cagino, Paul Feustel, Sridhar Reddy Musuku, Asim Raja, Natalie Bruno, Christopher Ursillo, Nathapong Arunakul, Constantine M Poulos, Michael Welljams-Dorof, Kevin Roberts, Mikhail Torosoff, and Augustine Delago.
• Department of Anesthesiology, Albany Medical Center Hospital, Albany, NY. Electronic address: panis@mail.amc.edu.
• J. Cardiothorac. Vasc. Anesth. 2017 Dec 1; 31 (6): 2049-2054.

ObjectiveThe aim of this study was to compare outcomes of monitored anesthesia care (MAC) versus general anesthesia (GA) for transfemoral transcatheter aortic valve replacement (TF-TAVR) and to describe a selection process for the administration of MAC.DesignRetrospective analysis of patients who underwent TF-TAVR under MAC or GA.SettingDepartment of Cardiac Anesthesia, Albany Medical Center, a tertiary university hospital.ParticipantsPatients selected for TF-TAVR.InterventionsPatients were divided into those who underwent MAC and those who underwent GA.Measurements And Main ResultsThe study comprised 104 consecutive patients (55% male, mean age 83 years) who underwent TF-TAVR under MAC (n = 60) or GA (n = 37) from 2014 to 2015. Seven patients were converted from MAC to GA and were omitted from analysis. There was no statistically significant difference between 30-day mortality and complications between the 2 groups. The MAC group had a significantly shorter median intensive care unit length of stay (48 h v 74 h, p = 0.0002). The MAC group also demonstrated reduced procedural time (45.5 min v 62 min, p = 0.003); operating room time (111 min v 153 min, p = <0.001); and fluoroscopy time (650 s v 690 s, p = 0.03).ConclusionsPatient selection for TF-TAVR with MAC can be formalized and implemented successfully. MAC allows for the minimizing of patient exposure to unnecessary interventions and improving resource utilization in suitable TAVR patients. Selection requires a multidisciplinary clinical decision-making process. MAC demonstrates good outcomes compared with GA, yet it is important to have a cardiac anesthesiologist present in the event of emergency conversion to GA.Copyright © 2017 Elsevier Inc. All rights reserved.

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