A Pilot Analysis of the Association Between Types of Monitored Anesthesia Care Drugs and Outcomes in Transfemoral Aortic Valve Replacement Performed Without General Anesthesia

Chen, Eric; Sukumar, Nitin; Dai, Feng; Akhtar, Shamsuddin; Schonberger, Robert B.

doi:10.1053/j.jvca.2017.07.009

Cited by 24 publications

(15 citation statements)

References 18 publications

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“…They also cited a single pilot study evaluating the use of dexmedetomidine in TAVR that did not include 30-day follow-up or cost. 11 The authors also referenced previous research showing reduced rates of acute kidney injury and delirium with dexmedetomidine although, inexplicably, they did not directly measure these complications in their study. The major industrysponsored low-, intermediate-, and high-risk studies did not report the incidence of delirium, and it also is not recorded by the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry.…”

Section: The Economics Of Transcatheter Aortic Valvementioning

confidence: 95%

The Economics of Transcatheter Aortic Valve Replacement and the Anesthesiologist

Neuburger

Rong

2021

Journal of Cardiothoracic and Vascular Anesthesia

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Section: The Economics Of Transcatheter Aortic Valvementioning

confidence: 95%

The Economics of Transcatheter Aortic Valve Replacement and the Anesthesiologist

Neuburger

Rong

2021

Journal of Cardiothoracic and Vascular Anesthesia

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“…They compared a "propofol dominant" anesthetic with a "dexmedetomidine plus propofol" anesthetic. 18 That study failed to show an association with delirium, ICU LOS, or hospital LOS.…”

mentioning

confidence: 95%

Anesthesia Matters: In Pursuit of the Interventions that Affect Outcomes in Transcatheter Aortic Valve Replacement

Neuburger

Patel

2018

Journal of Cardiothoracic and Vascular Anesthesia

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“…Most LAAO procedures have been traditionally performed under general anesthesia (GA), whereas other percutaneous interventional approaches to treat valve diseases such as transcatheter aortic valve replacement (TAVR) are increasingly performed under moderate conscious sedation (MCS) or so called “monitored anesthesia care” (MAC) or deep sedation (DS) 3‐5 . TEE is an essential imaging technique to guide LAAO procedures, and the main reason for GA requirement and thus overnight 1,2 .…”

Section: Introductionmentioning

confidence: 99%

Effectiveness and safety of same day discharge after left atrial appendage closure under moderate conscious sedation

Marmagkiolis

Ateş

Kose

et al. 2020

Cathet Cardio Intervent

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Background Left atrial appendage occlusion (LAAO) using Watchman device has become a world‐wide, well‐established therapeutic alternative to chronic systemic oral anticoagulation in patient who are at high‐risk of bleeding with paroxysmal (PAF) or chronic atrial fibrillation (Afib). Currently, LAAO procedures are performed under general anesthesia (GA) and patients stay overnight post procedure in the United States. We aimed to present the effectiveness and safety of same day discharge following LAAO under moderate conscious sedation (MCS) in patients without procedural complications. Methods A total of 112 patients between August 2019 and May 2020 with elevated CHA2DS2VASc (median score of 3) underwent transesophageal echocardiography (TEE)‐guided LAAO with FDA approved Watchman (Boston Scientific, MN) under MCS and discharged home on the same day 6 hr following their post procedural transthoracic echocardiogram (TTE) evaluations. All patients had next day TTE and follow up at the cardiology clinic. We prospectively evaluated clinical and procedural outcomes using medical records of these patients. Results Among all the patients, the mean age was 83.5 ± 8.5 years, 45 (40%) were women. Procedural duration, device implant time and fluoroscopic times were 45 ± 8.6, 14.5 ± 7.8 and 10.2 ± 1.2 min, respectively. The median required dosage of propofol was 105 ± 2.8 mg. No complications arose from MCS. There was no need for conversion to GA in any of the patients during the procedure. All patients were able to be discharged 6 hr following their TTE evaluation post procedure. There were no procedural complications. Conclusions Same day discharge following LAAO closure seems to be safe and effective in patients without procedural complications. LAAO can also be performed safely and effectively under moderate conscious sedation. Applying moderate conscious sedation may simplify the LAAO procedure, reduce procedural time, procedural costs and hospital stay while increasing overall patient satisfaction.

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A Pilot Analysis of the Association Between Types of Monitored Anesthesia Care Drugs and Outcomes in Transfemoral Aortic Valve Replacement Performed Without General Anesthesia

Abstract: A wide breadth of MAC medications is in use among TAVR patients and does not support differences in outcomes. Despite recommendations to reduce anesthetic drug dosing in the elderly, no significant trends in dose reduction with increasing age were noted.

Cited by 24 publications

References 18 publications

The Economics of Transcatheter Aortic Valve Replacement and the Anesthesiologist

The Economics of Transcatheter Aortic Valve Replacement and the Anesthesiologist

Anesthesia Matters: In Pursuit of the Interventions that Affect Outcomes in Transcatheter Aortic Valve Replacement

Effectiveness and safety of same day discharge after left atrial appendage closure under moderate conscious sedation

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