Open Surgical Access for Transfemoral TAVR Should Not Be a Contraindication for Conscious Sedation

Area of Science:

• Cardiology
• Anesthesiology
• Cardiovascular Surgery

Background:

• Monitored anesthesia care (MAC) is increasingly used for transcatheter aortic valve replacement (TAVR) in the US.
• General anesthesia (GA) remains common for TAVR procedures.
• Open surgical cutdown for transfemoral TAVR has typically been a contraindication for MAC.

Purpose of the Study:

• To evaluate the safety and outcomes of transfemoral TAVR performed with MAC in patients who underwent open surgical cutdown.
• To assess the rate of conversion to GA and postoperative complications in this patient cohort.

Main Methods:

• Retrospective study design using a prospectively recorded database.
• Analysis of 282 patients undergoing transfemoral TAVR with open surgical cutdown under MAC between 2015 and 2017 at a tertiary academic hospital.
• Evaluation of perioperative outcomes, including conversion to GA, pain scores, vascular complications, readmissions, and mortality.

Main Results:

• The study included 282 patients (mean age 82.7 years) with severe aortic stenosis.
• Only 3.9% of patients required conversion to GA.
• Low rates of major (0.7%) and minor (2.1%) vascular complications were observed, with acceptable postoperative pain scores and 30-day readmission rates (10.3%).

Conclusions:

• Transfemoral TAVR with open surgical cutdown can be safely performed using MAC and ilioinguinal block.
• This approach is associated with low conversion rates to GA and favorable postoperative outcomes.
• MAC provides a viable alternative to GA for selected TAVR patients requiring surgical cutdown for vascular access.