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Monitored Anesthesia Care versus General Anesthesia for Transcatheter Aortic Valve Replacement
  • +7
  • Henry Holmes,
  • Matheus Falasa,
  • Dan Neal,
  • Calvin Choi,
  • Ki Park,
  • Anthony Bavry,
  • Kirsten Freeman,
  • Eddie Manning,
  • Wade Stinson,
  • Eric Jeng
Henry Holmes
University of Florida
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Matheus Falasa
University of Florida Health
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Dan Neal
University of Florida Health
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Calvin Choi
University of Florida Health
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Ki Park
University of Florida Health
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Anthony Bavry
UT Southwestern
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Kirsten Freeman
University of Florida
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Eddie Manning
University of Florida Health
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Wade Stinson
University of Florida Health
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Eric Jeng
University of Florida Health
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Abstract

Background: Monitored Anesthesia Care (MAC) has been increasingly used in lieu of general anesthesia (GA) for transcatheter aortic valve replacement (TAVR). We sought to compare outcomes and in-hospital costs between MAC and GA for TAVR at a single center Veterans Affairs Medical Center. Methods: A single-center retrospective review of 349 patients who underwent TAVR (MAC, n = 244 vs. GA, n = 105) from January 2014 to December 2019 was performed. Baseline patient characteristics, operating room (OR) time, intensive care unit (ICU) length of stay (LOS) and cost, total LOS, hospital cost, total cost, and complication rates were collected. Propensity matching was performed and resulted in 83 matched pairs. Results: In the unmatched TAVR cohort, MAC TAVR was associated with reduced OR time (146 vs. 198 minutes, P < .0001), ICU LOS (1.4 vs. 1.8 days, P < 0.0001), total hospital LOS (3.4 vs. 5.4 days, P < .0001), and lower index total cost ($81,3000 vs. $85,400, P = .010). After propensity matching, MAC TAVR patients had reduced OR time (146 vs. 196 minutes, P < 0.05), ICU LOS (1.2 vs. 1.7 days, P = .006), total LOS (3.5 vs. 5.1 days, P = .001), and 180-day mortality (2.4% vs. 12%, P < 0.03). There was no difference in total hospitalization cost or total cost. Conclusions: In propensity matched groups, TAVR utilizing MAC is associated with improved OR time efficiency, decreased LOS, and a reduction in 180-day mortality, but no significant difference in cost.