Sedation Versus General Anaesthesia for Transcatheter Aortic Valve Replacement (TAVR)
Hossam Abdelfatah Alnsour
Department of Cardiac Anaesthesia, Queen Alia Heart Institute, Jordan.
Ade Fahmi Almomanie
Department of Cardiac Anaesthesia, Queen Alia Heart Institute, Jordan.
Khalid Awad Al-Rawabdeh
Department of Cardiac Anaesthesia, Queen Alia Heart Institute, Jordan.
Qais Khalil Alqsoos
Department of Cardiac Anaesthesia, Queen Alia Heart Institute, Jordan.
Khaled Nayef Nicola AL-Malouf
Department of Cardiac Surgery, Queen Alia Heart Institute, Jordan.
Ashraf Fadel Moh’d *
Department of Cardiac Anaesthesia, Queen Alia Heart Institute, Jordan.
*Author to whom correspondence should be addressed.
Abstract
Background: There is a debate regarding the best anaesthetic management for patients undergoing trans-catheter aortic valve replacement (TAVR). Both sedation and general anesthesia are used by anesthetists.
Objective: This study aims to compare the use of sedation and general anesthesia in trans-catheter aortic valve replacement.
Methods: Retrospective observational analysis of patients’ data presented for trans-catheter aortic valve replacement (TAVR) at Queen Alia Heart Institute (QAHI) over 5 years (in the period between February 2020 and March 2025). Patients were divided into two groups regarding their anaesthetic technique during the procedure: the general anaesthetic group (GA) and the sedation group. Both groups were compared according to their demographic, clinical, perioperative characteristics, hospital stay, complications, and outcomes.
Results: 69 patients underwent the TAVI procedure. The average age of patients was 76.7 years (ranging from 57 to 93 years). Female patients were 57.9 %. Female to male ratio was 1.4:1. The average BMI was 31.5 Kg/m². Incidence of comorbidities was high among the TAVI population: 91.3% were hypertensive, 49.3% were diabetic, 11.6% had hypothyroidism, 8.7% had a previous cerebrovascular accident (CVA) or transient ischemic attack (TIA), 7.2% had chronic respiratory disease and 10.1% had chronic kidney disease (CKD). The incidence of smoking was 30.4%. The average pre-procedural mean pressure gradient across the aortic valve was 49.4 mmHg. TAVI was performed under sedation in more than half of patients (56.5%), while 43.5% had a general anaesthetic. The average length of hospital stay was 3.9 days after the procedure. Patients who had the procedure performed under sedation had a shorter hospital stay (3.6 days) in comparison to the GA group (4 days). The overall mortality was 5.8%.
Conclusion: TAVI procedure is more commonly performed under conscious sedation than general anesthesia in our cardiac center. The use of conscious sedation was associated with shorter hospital stay than general anesthesia.
Keywords: Anaesthesia, cardiac, sedation, TAVI, outcome, hospital stay