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43 Comparing outcomes in patients undergoing tavi: general anaesthetic versus conscious sedation
  1. C Lee,
  2. I Casserly,
  3. E Fahy
  1. Mater Misericordiae Hospital, Dublin, Ireland


Introduction The Transcatheter Aortic Valve Insertion (TAVI) experience has been evolving globally for over a decade and a half. The first ever in-human TAVI was carried out in 2002 and was performed under mild sedation and local anaesthesia (1). As TAVI has progressed from a novel therapy to a mainstream treatment it has been adopted worldwide as the standard treatment for severe aortic stenosis in symptomatic patients who have contraindications or other considerations that are prohibitive to surgical aortic valve replacement (SAVR). Despite growing data on TAVI, consensus on best anaesthetic approach is yet to be reached. The recent WRITTEN survey of over 70,000 TAVI procedures worldwide reveals that general anaesthesia (GA) remains the preference in 60% of centres (2). Despite GA remaining the favored approach, a number of studies have demonstrated a trend towards conscious sedation (non-GA) (3 4). The advantages of conscious sedation over GA are thought to include improved recovery time and reduced reliance on anaesthetic staff. The impact of anaesthesia type on patient outcome was analysed using data from the recent CoreValve ADVANCE study. Using propensity score-matching analysis, the characteristics and outcomes of patients who underwent TAVI with either GA or non-GA were compared. The study demonstrated no statistical difference between GA and non-GA groups in all-cause mortality, cardiovascular mortality, or stroke through 2-year follow-up. Length of hospital stay was similar between the two groups (5).

Methods Using data from the newly formed Mater Hospital TAVI database we compared key patient outcomes against anaesthesia type. Patients were divided into general anaesthetic group (TAVI-GA), conscious sedation directed by anaesthesia staff (TAVI-SA) and conscious sedation directed by cardiology staff (TAVI-SC). Measured outcomes included procedure time, length of ICU stay, need for vasopressor support and over all length of hospital stay.

Conclusions The statistical analysis for this study is ongoing with results expected May 2017. Overall this study aims to add to the growing body of international data regarding anaesthesia choice in TAVI. It will also compare Mater Hospital data against similar studies. Looking to the future a randomised control trial would likely be the design of choice to help better reach an international consensus. Planning and implementing such a trial would be difficult given the clinical complexity of typical TAVI candidates by their nature.

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