Comparing outcomes of general anesthesia and monitored anesthesia care during <scp>transcatheter</scp> aortic valve replacement: The Cleveland Clinic Foundation experience

Sammour, Yasser; Kerrigan, Jimmy; Banerjee, Kinjal; Gajulapalli, Rama Dilip; Lak, Hassan Mehmood; Chawla, Sanchit; Andress, Krystof; Gupta, Neha; Unai, Shinya; Svensson, Lars; Yun, James; Reed, Grant W.; Alfirevic, Andrej; Sale, Shiva; Mehta, Anand; Krishnaswamy, Amar; Skubas, Nikolaos J.; Kapadia, Samir

doi:10.1002/ccd.29496

Cited by 18 publications

(16 citation statements)

References 21 publications

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“…Several studies have compared costs between MAC and GA in TAVR. 14,24,25,32–34 This study demonstrated significant differences between anesthesia modalities in OR time, ICU LOS, and total LOS after propensity matching. It was hypothesized that these differences would translate to reductions in patient charges, but this was not the case.…”

Section: Discussionmentioning

confidence: 65%

“…Other comparisons of high-risk patients, confounded by baseline differences between groups, have demonstrated reduced OR, ICU, and total hospital LOS times with the use of MAC for TAVR. 32,34 With the inclusion of intermediate-risk and low-risk patients, the data presented herein offers more generalizability to the population currently treated with TAVR. Hospital and operator volume have been demonstrated to be associated with outcomes in TAVR.…”

Section: Discussionmentioning

confidence: 99%

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Monitored Anesthesia Care Versus General Anesthesia for Transcatheter Aortic Valve Replacement

Holmes

Falasa

Neal

et al. 2022

Innovations�(Phila)

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Objective: 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 Veterans Affairs Medical Center. Methods: A single-center retrospective review was performed of 349 patients who underwent transfemoral TAVR (MAC, n = 244 vs GA, n = 105) from January 2014 to December 2019. 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 min, P < 0.001), ICU LOS (1.4 vs 1.8 days, P < 0.001), total hospital LOS (3.4 vs 5.4 days, P < 0.001), and lower index total cost ($81,300 vs $85,400, P = 0.010). After propensity matching, MAC TAVR patients had reduced OR time (146 vs 196 min, P < 0.05), ICU LOS (1.2 vs 1.7 days, P = 0.006), total LOS (3.5 vs 5.1 days, P = 0.001), 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.

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Monitored Anesthesia Care Versus General Anesthesia for Transcatheter Aortic Valve Replacement

Holmes

Falasa

Neal

et al. 2022

Innovations�(Phila)

View full text Add to dashboard Cite

show abstract

“…34 Several studies have compared costs between MAC and GA in TAVR. 14,24,25,[35][36][37] This study demonstrated significant differences between anesthesia modalities in OR time, ICU LOS, and total LOS after propensitymatching. It was hypothesized that these differences would translate to reductions in patient charges, but this was not the case.…”

Section: Commentmentioning

confidence: 59%

“…Other comparisons of high-risk patients, confounded by baseline differences between groups, have demonstrated reduced OR, ICU, and total hospital LOS times with the use of MAC for TAVR. 35,37 With the inclusion of intermediate and low risk patients, the data presented herein offers more generalizability to the population currently treated with TAVR.…”

Section: Commentmentioning

confidence: 99%

Monitored Anesthesia Care versus General Anesthesia for Transcatheter Aortic Valve Replacement

Neal

et al. 2021

Preprint

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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.

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“…MAC could lead to less haemodynamic instability due to the absence of stronger anaesthetic drugs such as those used in general anaesthesia. MAC has been shown to have similar to better safety outcomes than general anaesthesia with shorter hospital and intensive care unit length of stay 17 18…”

Section: Discussionmentioning

confidence: 99%

Management of concurrent aortic stenosis and pheochromocytoma

et al. 2022

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A man in his mid 60s with known aortic stenosis developed progressive symptoms. Echocardiography confirmed severe calcific aortic stenosis. Further evaluation revealed an elevated white blood cell count leading to a diagnosis of chronic lymphocytic leukaemia. CT of the abdomen revealed a left adrenal mass, confirmed by MRI. 24-hour urine catecholamines were elevated, confirming the diagnosis of a pheochromocytoma.This case was complicated by the concurrent aortic stenosis and pheochromocytoma, requiring considerable multidisciplinary teamwork to develop a safe management strategy. A decision to perform a transcatheter aortic valve replacement (TAVR) with alpha and beta blockade with monitored anaesthesia care followed by laparoscopic adrenalectomy and postoperative haemodynamic control was made. A successful TAVR procedure was performed, complicated only by postoperative transient atrial tachycardia followed 6 weeks later by a laparoscopic robotic-assisted left adrenalectomy. The patient recovered fully and was discharged 2 days later.

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Comparing outcomes of general anesthesia and monitored anesthesia care during transcatheter aortic valve replacement: The Cleveland Clinic Foundation experience

Cited by 18 publications

References 21 publications

Monitored Anesthesia Care Versus General Anesthesia for Transcatheter Aortic Valve Replacement

Monitored Anesthesia Care Versus General Anesthesia for Transcatheter Aortic Valve Replacement

Monitored Anesthesia Care versus General Anesthesia for Transcatheter Aortic Valve Replacement

Management of concurrent aortic stenosis and pheochromocytoma

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