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General anesthesia versus conscious sedation in transcatheter aortic valve replacement: experience from a growing structural cardiology program in the Midwest

Bishal Bhandari, Manjari Regmi, Abdisamad Ibrahim, Basma Albast, Cameron Koester, Priyanka Parajuli, Mohammad Al-Akchar, Michael Buhnerkempe, Alexander Worix, Abhishek Kulkarni

Introduction: Transcatheter Aortic Valve Replacement (TAVR) has been established as a viable alternative to surgical aortic valve replacement (SAVR) when treating symptomatic aortic stenosis in intermediate and high risk patients. Historically, general endotracheal anesthesia (GETA) has been the primary form of patient sedation during TAVR. Recently, conscious sedation (CS) has been utilized as a safe option. As there are limited data available comparing these two modalities, it would be helpful to investigate this question further. Methods: To determine the potential benefits of using conscious sedation compared to general anesthesia, 3 outcomes were compared in patients experiencing each method: (1) Total hospital length of stay (LOS), (2) ICU LOS, and (3) occurrence of adverse events (AEs) during hospitalization. Results: Hospital LOS and ICU LOS were found to have a correlation with anesthesia method. CS was correlated with shorter hospital and ICU stays compared to GETA. There were no significant differences between CS and GETA in terms of occurrence of AEs, indicating that the risk of complications was similar for both anesthesia methods. Conclusion: Conscious sedation compared to general anesthesia could potentially be the better alternative for TAVR with no increased adverse events.