title: Transcatheter aortic valve replacement under monitored anesthesia care versus general anesthesia with intubation.
abstract: OBJECTIVE
  Most transcatheter aortic valve replacement (T-AVR) using the Edwards SAPIEN transcatheter heart valve (Edwards Lifesciences, Irvine, CA) is done under general anesthesia. The present study aimed to examine the feasibility and safety of T-AVR under monitored anesthesia care and aimed to compare the clinical outcome to the outcome of patients who underwent general anesthesia.
  
  
  METHODS
  The analysis included 92 consecutive patients undergoing T-AVR via the transfemoral approach guided by transesophageal echocardiography using the Edwards SAPIEN valve. The cohort was divided into two groups: I, monitored anesthesia care (n=70; 76.1%) and II, intubation (n=22; 23.9%). Monitored anesthesia care was given by anesthesiologists in one of two protocol regimens: Ketamine & Propofol or Dexmedetomidine. The crossover rate to general anesthesia and the clinical outcome of these two groups were compared.
  
  
  RESULTS
  Baseline clinical characteristics of the two groups were similar, except for higher logistic EuroSCORE and prior stroke in the monitored anesthesia care group. Surgical access of the femoral artery was performed in 15 (68.1%) from the general anesthesia group and in 24 (34.2%) from the monitored anesthesia care group, p=0.05. The median procedure duration was significantly lower in the monitored anesthesia care group (91 vs. 155 min, p=0.008) and there was a trend to lower median intensive care unit stay and hospital stay (27 vs. 72 h, p=0.07 and 5 vs. 7.5 days, p=0.06, respectively). Of the patients with monitored anesthesia care, 8 (11.4%) converted to general anesthesia.
  
  
  CONCLUSIONS
  T-AVR using the Edwards SAPIEN valve can be performed in the majority of cases with controlled monitored anesthesia care, thereby avoiding the necessity of general anesthesia and resulting in shorter procedure time and in-hospital length of stay.
authors: Washington Hospital Center, Washington, DC 20010, USA.
authors: Itsik
authors: I
authors: Ben-Dor
authors: Patrick M
authors: PM
authors: Looser
authors: Gabriel
authors: G
authors: Maluenda
authors: Travis C
authors: TC
authors: Weddington
authors: Nicholas G
authors: NG
authors: Kambouris
authors: Israel M
authors: IM
authors: Barbash
authors: Camille
authors: C
authors: Hauville
authors: Petros
authors: P
authors: Okubagzi
authors: Paul J
authors: PJ
authors: Corso
authors: Lowell F
authors: LF
authors: Satler
authors: Augusto D
authors: AD
authors: Pichard
authors: Ron
authors: R
authors: Waksman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia / Q000009:adverse effects / Q000379:methods*; D000768:Anesthesia, General / Q000009:adverse effects; D019162:Anesthetics, Combined; D000778:Anesthetics, Dissociative; D018686:Anesthetics, Intravenous; D001024:Aortic Valve Stenosis / Q000503:physiopathology / Q000628:therapy*; D001794:Blood Pressure; D001795:Blood Pressure Determination / Q000295:instrumentation; D015924:Blood Pressure Monitors; D006328:Cardiac Catheterization / Q000009:adverse effects; D016009:Chi-Square Distribution; D020927:Dexmedetomidine; D004219:District of Columbia; D017548:Echocardiography, Transesophageal; D005240:Feasibility Studies; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D006993:Hypnotics and Sedatives; D007442:Intubation, Intratracheal / Q000009:adverse effects; D007649:Ketamine; D007902:Length of Stay; D008297:Male; D015742:Propofol; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D019162:Anesthetics, Combined; D000778:Anesthetics, Dissociative; D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D007649:Ketamine; D015742:Propofol