March 14, 2017 — Transcatheter aortic valve replacement (TAVR) for aortic stenosis continues to evolve with the adoption of methods intended to maximize efficacy, safety and patient recovery. Researchers at the Valve Science Center at Minneapolis Heart Institute Foundation recently conducted quality improvement review to examine the impact of the use of minimal anesthesia with conscious sedation (CS) in patients with severe, symptomatic aortic stenosis (AS) undergoing TAVR.
Using a multidisciplinary collaboration, a program was initiated to perform transfemoral TAVR with CS to treat patients with native valve AS. Clinical outcomes for the first 50 patients treated with CS were compared to 50 control patients who had undergone TAVR with general anesthesia (GA) immediately preceding CS implementation. The two patient groups were similar with respect to age, hemodynamic severity of AS, symptom status and frailty. However, in comparison to GA patients, those who had TAVR with CS had shorter median procedure time and hospital length-of-stay (LOS). Procedural success with TAVR and major adverse complications were similar between the groups. Overall, implementation of TAVR with CS led to a $2,833 reduction in median total variable costs per treated patient. Researchers concluded the implementation of a multidisciplinary program that enabled TAVR to be performed with CS led to significant reductions in LOS and hospital costs, without affecting the effectiveness and safety of the procedure.
“The evidence and insight gathered in this analysis supports a novel shift in how we manage our transfemoral TAVR patient population going forward,” said Marcus Burns, DNP, principal investigator at the Minneapolis Heart Institute Foundation. “Conscious sedation, with its ability to maximize the ease of recovery from TAVR procedures, is a huge advancement for the many patients afflicted with aortic stenosis who seek treatment at our facility." To date, researchers at the Valve Science Center at Minneapolis Heart Institute Foundation have performed more than 120 conscious sedation TF-TAVR’s since February 2016. “While interest in using conscious sedation for TAVR is steadily growing and a majority of centers have not yet adopted or just are beginning to adopt this approach in its true form," Burns explained.
The researchers will present their results at the American College of Cardiology (ACC) annual scientific session and expo this month.