Feature | Heart Valve Technology | May 16, 2016

Moderate Sedation Shows Promise for TAVR Patients

Late-breaker study at SCAI shows less anesthesia may help improve TAVR outcomes

A Medtronic CoreValve TAVR device being deployed under angiographic image guidance.

 


May 16, 2016 — The largest observational study of percutaneous transfemoral transcatheter aortic valve replacement (TAVR) demonstrated that moderate sedation use is associated with improved patient outcomes, including lower 30-day mortality and shorter hospital stays, as compared to traditional general anesthesia. This STS/ACC TVT Registry analysis was presented as a late-breaking clinical trial at the 2016 Society for Cardiovascular Angiography and Interventions (SCAI) annual meeting. 

TAVR has become the therapy of choice for patients who are considered at extreme or high-risk for standard open surgical aortic valve replacement, with recent data supporting extension of the therapy into intermediate-risk populations. While general anesthesia has been typically administered during these cases, rates of moderate sedation use for this minimally invasive technique are increasing. 

“TAVR is revolutionary, but the question we asked ourselves is what novel techniques are being employed to make the therapy even better and as noninvasive as possible?” said Jay Giri, M.D., MPH, an assistant professor of cardiovascular medicine in the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, and the study’s senior investigator. “Now that we are routinely treating patients without incisions, is moderate sedation a safe and effective option for TAVR?” 

Investigators compared the effectiveness of moderate sedation and general anesthesia use among STS/ACC TVT Registry patients between April 2014 and June 2015. The registry is comprised of all U.S. TAVR patients and elective cases treated via percutaneous transfemoral approach and all were included in the analysis. A total of 10,997 patients were assessed, and of these 1,737 (15.8 percent) received moderate sedation. 

While both patient groups had nearly equal rates of TAVR success (98.4 vs. 98.6 percent, p=0.46), moderate sedation patients experienced lower rates of 30-day mortality (2.92 vs. 4.08 percent, p=0.035), 30-day mortality or stroke (4.8 vs. 6.4 percent, p=0.019), and briefer hospital stays (6+/-10.7 vs. 6.7 +/9.6 days, p<0.0001).  

Importantly, propensity-matched analyses, which accounted for factors known to predict 30-day TAVR mortality, confirmed lower 30-day mortality (2.96 vs. 4.01 percent, p<0.0001) and 30-day mortality or stroke (4.8 vs. 6.36 percent, p<0.0001) among the moderate sedation patients. Nationally, 5.9 percent of moderate sedation patients converted to general anesthesia, which was comparable to the 5.2 percent rate observed at the University of Pennsylvania Health System according to Giri. 

“This compelling data shows that moderate sedation is both safe and effective. While it is important to assess each patient individually, using moderate sedation could result in a better experience and better clinical outcomes for patients,” said Giri. “A broad shift towards moderate sedation for TAVR could have profound implications for care pathways, costs and the future of this technology.” 

Giri reports grants to the institution from St. Jude Medical for service as site co-primary investigator of the PORTICO trial of transcatheter aortic valve replacement. 

 

Related Content for Conscious Sedadtion and TAVR:

VIDEO: Conscious Sedation for TAVR Procedures

VIDEO: The State of TAVR in 2016

Conscious Sedation TAVR Reduced Length-of-Stay and Hospital Costs

Michigan Hospital Employing Conscious Sedation for Aortic Aneurysm Repair

Moderate Sedation Shows Promise for TAVR Patients

UTHealth, Memorial Hermann Perform Conscious Sedation TAVR Procedure

 

For more information: www. SCAI.org/SCAI2016 

 

Related Content

News | Cath Lab
April 25, 2022 – NewYork-Presbyterian Hudson Valley Hospital celebrated the launch of its interventional cardiology ...
Home April 25, 2022
Home
News | Cath Lab
April 18, 2022 – Royal Philips and Oulu University Hospital (Finland) have announced a strategic 10-year partnership ...
Home April 18, 2022
Home
News | Cath Lab
February 16, 2022 – Fremont Bank Foundation recently donated $750,000 to its community partner, St. Rose Hospital ...
Home February 16, 2022
Home
News | Cath Lab
February 14, 2022 — A collaborative effort between The Valley Heart and Vascular Institute’s cardiology team ...
Home February 14, 2022
Home
Sponsored Content | Videos | Cath Lab

Advancements in analytics and data visualizations are helping to streamline operations and improve productivity at cath ...

Home January 13, 2022
Home
News | Cath Lab

January 4, 2022 — The U.S. Food and Drug Administration (FDA) has authorized marketing of the first laser-based device ...

Home January 04, 2022
Home
News | Cath Lab

December 14, 2021 — RSIP Vision, a medical imaging company applying advanced artificial intelligence (AI) and computer ...

Home December 14, 2021
Home
Feature | Cath Lab

November 15, 2021 — RealView Imaging Ltd. recently received FDA 510(k) clearance for its Holoscope-i holographic system ...

Home November 15, 2021
Home
News | Cath Lab

November 10, 2021 — Shockwave Medical a pioneer in the development of Intravascular Lithotripsy (IVL) to treat severely ...

Home November 10, 2021
Home
News | Cath Lab

November 10, 2021 — Philips Healthcare announced North American availability of new innovations in its portfolio of ...

Home November 10, 2021
Home
Subscribe Now