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

TCT cancels in-person meeting and goes virtual due to COVID-19
News | Cath Lab | May 27, 2020
May 27, 2020 — To ensure the health and safety of all attendees due to the ongoing COVID-19 (SARS-CoV-2) pandemic, th
Patients undergoing cardiac catheterization are traditionally instructed to follow nothing by mouth, or nil per os (NPO), as there are no current standardized fasting protocols, but the CHOWNOW study found patients do not need to fast and will have similar outcomes. #SCAI2020
Feature | Cath Lab | May 18, 2020
May 18, 2020 – Patients undergoing cardiac catheterization are traditionally instructed to follow nothing by mouth, o
Ehtisham Mahmud, M.D., FSCAI, president of the Society for Cardiovascular Angiography and Interventions (SCAI) and chief, Division of Cardiovascular Medicine at UC San Diego Medical Center,
Podcast | Cath Lab | May 13, 2020
This podcast is an interview with Ehtisham Mahmud, M.D., FSCAI, president of the Society for Cardiovascular Angiograp
Nuance Communications Inc. introduced Nuance Cardiovascular CAPD, a new computer-assisted physician documentation (CAPD) solution designed to help cardiologists improve the quality of complex documentation and the accuracy of reimbursement for cardiac catheterization procedures. The Nuance Cardiovascular CAPD solution is available through a partnership with ZHealth for this solution, which is based on patented algorithms built with ZHealth’s interventional documentation and coding expertise.
News | Cath Lab | January 31, 2020
January 29, 2020 – Nuance Communications Inc.
Videos | Cath Lab | January 09, 2020
Haval Chweich, M.D., medical director of the cardiac critical care unit (CCU) at Tufts Medical Center, and assistant...
People watch the live presentation of the five-year EXCEL Trial data by Gregg Stone, M.D., in the Abbott booth at TCT 2019. Abbott makes the Xience stent used in the trial, which compared equally with long-term CABG surgical outcomes.  In early December 2019, leaders of the European Association for Cardiothoracic Surgery (EACTS) withdrew their support for European practice guidelines that endorse the use of coronary stents in many patients with left main coronary artery disease.

People watch the live presentation of the five-year EXCEL Trial data by Gregg Stone, M.D., in the Abbott booth at TCT 2019. Abbott makes the Xience stent used in the trial, which compared equally with long-term CABG surgical outcomes.

News | Cath Lab | January 02, 2020 | Dave Fornell, Editor
January 2, 2020 — In early December 2019, leaders of the European As...