Outcomes of Non-Anesthetist Led Conscious Sedation for 2000 Transcatheter Aortic Valve Implantations

A minimalist approach to transcatheter aortic valve replacement (TAVR) has accompanied the increase in TAVR procedures worldwide. Comprehensive evidence regarding the safety of non-anesthetist-led conscious sedation for TAVR is lacking.

We aimed to evaluate the outcomes of patients undergoing TAVR with non-anesthetist-led conscious sedation.

This retrospective analysis included consecutive patients who underwent percutaneous transfemoral TAVR with non-anesthetist-led conscious sedation, from March 2018 to 2025, in a single high-volume center. Thirty-day outcomes were assessed.

Of 2854 patients who underwent TAVR, 2000 (70.1%) had non-anesthetist-led conscious sedation (age: 80.7 ± 6.5 years, 42.1% female). The annual proportion of non-anesthetist-led conscious sedation procedures increased from 37% (2018-2019) to 81% (2024-2025). Fentanyl was administered to 1986 (99.3%) patients (median: 75 mcg [IQR: 50-100]) and Midazolam to 945 (47.3%) patients (median: 1.5 mg [IQR: 1.0-2.0]). Mean procedural duration was 81.3 ± 67.7 min. Emergency anesthetic support was required for 53 (2.7%) patients, due to: vascular access complications (n = 15), cardiac arrest (n = 14), annular rupture/aortic dissection (n = 9), profound hypotension (n = 8), agitation (n = 4), ventricular perforation (n = 2) and reduced consciousness (stroke) (n = 1). Conversion to general anesthesia was required for 24 (1.2%) patients. Emergency bail-out surgery (cardiac/vascular) was undertaken in 15 patients (0.75%). Among the 2000 patients, 30-day mortality was 1.3%, and VARC-3 technical success, device success, and early safety were achieved in 97.2%, 92.7%, and 78.9% of patients, respectively.

Non-anesthetist-led conscious sedation can be delivered safely in most patients undergoing percutaneous transfemoral TAVR. The need for emergency anesthetic support is low.