Monitored Anesthesia Care Versus General Anesthesia for Transcatheter Aortic Valve Replacement

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Henry R Holmes1, Matheus Falasa1, Daniel Neal2

  • 1Division of Cardiovascular Surgery, Department of Surgery, University of Florida Health, Gainesville, FL, USA.

Innovations (Philadelphia, Pa.)
|October 11, 2022
PubMed
Abstract

Insights

Monitored anesthesia care (MAC) for transcatheter aortic valve replacement (TAVR) reduces operating room time, length of stay, and 180-day mortality compared to general anesthesia (GA). Costs were not significantly different between the two anesthesia methods.

Area of Science:

  • Cardiology
  • Anesthesiology
  • Health Services Research

Background:

  • Monitored anesthesia care (MAC) is increasingly replacing general anesthesia (GA) for transcatheter aortic valve replacement (TAVR).
  • Comparative outcome data between MAC and GA for TAVR are essential for clinical decision-making.

Purpose of the Study:

  • To compare clinical outcomes and in-hospital costs of MAC versus GA for TAVR.
  • To evaluate the efficiency and safety of MAC in TAVR procedures.

Main Methods:

  • A single-center retrospective review of 349 patients undergoing transfemoral TAVR from 2014 to 2019.
  • Data collected included operating room time, intensive care unit and total length of stay, and costs.
  • Propensity matching was used to create 83 comparable pairs of patients (MAC vs. GA).

Main Results:

  • MAC TAVR was associated with significantly reduced operating room time, ICU length of stay, and total hospital length of stay in both unmatched and propensity-matched cohorts.
  • Propensity-matched MAC TAVR patients demonstrated a significant reduction in 180-day mortality (2.4% vs. 12%).
  • No significant differences were observed in total hospitalization cost or overall total cost between MAC and GA groups.

Conclusions:

  • Transcatheter aortic valve replacement performed with monitored anesthesia care offers improved operating room efficiency and reduced length of stay.
  • Monitored anesthesia care is associated with a significant decrease in 180-day mortality for TAVR patients.
  • While MAC improves efficiency and reduces mortality, it does not significantly impact overall costs compared to general anesthesia.
Keywords:
cardiac anesthesiacost analysisendovascular proceduresquality improvementtranscatheter aortic valve replacement

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