Conscious Sedation Versus General Anesthesia for Transcatheter Aortic Valve Replacement

Butala, Neel M.; Chung, Mabel; Secemsky, Eric A.; Manandhar, Pratik; Marquis‐Gravel, Guillaume; Kosinski, Andrzej S.; Vemulapalli, Sreekanth; Yeh, Robert W.; Cohen, David J.

doi:10.1016/j.jcin.2020.03.008

Cited by 90 publications

(78 citation statements)

References 17 publications

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“…In our study, 61% of patients were assessed beforehand as feasible to undergo TAVR using conscious sedation, with one patient requiring conversion to general anesthesia due to a vascular complication necessitating surgical repair. This rate is similar to the recently reported proportion of 64% undergoing transfemoral TAVR under conscious sedation among 120,080 patients in the TVT Registry 19 . Conversely, while a continued TAVR program is feasible on an organizational level, we want to highlight that the continuation of non‐COVID‐19 related care during this unprecedented pandemic in modern times is not without risks for the patient.…”

Section: Discussionsupporting

confidence: 84%

Transcatheter aortic valve replacement during the COVID‐19 pandemic—A Dutch single‐center analysis

Rooijakkers

Wollersheim

et al. 2020

J Card Surg

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Background and Aim of the Study: The coronavirus disease 2019 (COVID-19) pandemic has put an enormous strain on healthcare systems and intensive care unit (ICU) capacity, leading to suspension of most elective procedures, including transcatheter aortic valve replacement (TAVR). However, deferment of TAVR is associated with significant wait-time mortality in patients with severe aortic valve stenosis. Conversely, there is currently no data available regarding the safety and feasibility of a continued TAVR program during this unprecedented crisis. The aim of this study is to evaluate the safety and feasibility of patients undergoing TAVR during the COVID-19 pandemic in our center, with specific emphasis on COVID-19 related outcomes. Methods: All patients who underwent TAVR in our center between February 27, 2020, and June 30, 2020, were evaluated. Clinical outcomes were described in terms of Valve Academic Research Consortium 2 definitions. Patient follow-up was done by chart review and telephone survey. Results: A total of 71 patients have undergone TAVR during the study period. Median age was 80 years, 63% were men, and 25% were inpatients. Procedural success was 99%. After TAVR, 30% involved admission to the ICU, and 94% were ultimately discharged to the cardiac care unit on the same day. Two patients (3%) had confirmed COVID-19 a few days after TAVR, and both died of COVID-19 pneumonia within 2 weeks after hospital discharge. Conclusions: A continued TAVR program during the COVID-19 pandemic is feasible despite limited hospital resources. However, COVID-19 related mortality after TAVR is of concern.

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Section: Discussionsupporting

confidence: 84%

Transcatheter aortic valve replacement during the COVID‐19 pandemic—A Dutch single‐center analysis

Rooijakkers

Wollersheim

et al. 2020

J Card Surg

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“…Recent data from the Transcatheter Valve Therapy (TVT) Registry have shown a steady increase in the use of moderate sedation for TAVR, with improved safety and recovery. 4,5 The majority of TAVR procedures do not require ICU recovery after the procedure, and this is important as critical care beds will be limited during the COVID-19 crisis in parts of the country. Percutaneous coronary intervention should be performed prior to TAVR only when coronary artery disease is contributing to the patient's clinical presentation or would pose a high risk for the TAVR procedure.…”

Section: Procedural Considerations For Tavr During the Covid-19 Panmentioning

confidence: 99%

Triage considerations for patients referred for structural heart disease intervention during the COVID‐19 pandemic: An ACC/SCAI position statement

Shah

Welt

Mahmud

et al. 2020

Cathet Cardio Intervent

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The coronavirus disease‐2019 (COVID‐19) pandemic has strained health care resources around the world, causing many institutions to curtail or stop elective procedures. This has resulted in an inability to care for patients with valvular and structural heart disease in a timely fashion, potentially placing these patients at increased risk for adverse cardiovascular complications, including CHF and death. The effective triage of these patients has become challenging in the current environment, as clinicians have had to weigh the risk of bringing susceptible patients into the hospital environment during the COVID‐19 pandemic against the risk of delaying a needed procedure. In this document, the authors suggest guidelines for how to triage patients in need of structural heart disease interventions and provide a framework for how to decide when it may be appropriate to proceed with intervention despite the ongoing pandemic. In particular, the authors address the triage of patients in need of transcatheter aortic valve replacement and percutaneous mitral valve repair. The authors also address procedural issues and considerations for the function of structural heart disease teams during the COVID‐19 pandemic.

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“…Local anesthesia with conscious sedation may be considered as the best anesthesia technique during this crisis provided that the patient is not in decompensated heart failure, can lie flat in the bed, and not morbidly obese. However, the anesthesia team should be prepared to use general anesthesia at any time during the procedure [ 15 – 17 ]. This approach is particularly crucial at this crisis, where the majority of TAVI patients will not utilize the intensive care unit for their recovery after the procedure, and this is important as critical care beds will be limited during the COVID-19 crisis in many countries.…”

Section: Procedural Considerations For Tavi During the Covid-19 Pamentioning

confidence: 99%

The Impact of COVID-19 Pandemic on the Hospital Management of TAVI Patients: TAVI team Thoughts and Recommendation

Balghith¹,

Arifi²,

Ahmed³

et al. 2020

Journal of the Saudi Heart Association

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The COVID-19 Pandemic has put enormous pressure on the healthcare system globally, causing many healthcare organizations all over the world to cancel or stop elective procedures in their cardiac catheterization laboratoires. This delay in elective procedures with no doubt has led to a suspension of patient care primarily to those with severe aortic stenosis, which might place them at higher risk for cardiovascular complications like sudden death and heart failure. Health Care Worker are faced with the uncertainty of contracting infections while performing procedures in patients with a confirmed diagnosis of COVID-19 or suspected cases. This unprecedented situation is very challenging for the safety of Health Care Worker. Hence, in this article, we aim to summarize some of the current guidelines as to how to triage patients in need for Trans Catheter Aortic Valve Implantation (TAVI), during this ongoing pandemic, and will address some necessary considerations related to the preparation of catheterization laboratories and personal during the COVID-19 pandemic.

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Conscious Sedation Versus General Anesthesia for Transcatheter Aortic Valve Replacement

Cited by 90 publications

References 17 publications

Transcatheter aortic valve replacement during the COVID‐19 pandemic—A Dutch single‐center analysis

Transcatheter aortic valve replacement during the COVID‐19 pandemic—A Dutch single‐center analysis

Triage considerations for patients referred for structural heart disease intervention during the COVID‐19 pandemic: An ACC/SCAI position statement

The Impact of COVID-19 Pandemic on the Hospital Management of TAVI Patients: TAVI team Thoughts and Recommendation

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