Sedation Versus General Anaesthesia for Transcatheter Aortic Valve Replacement (TAVR)

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.