Dexmedetomidine Is an Equal Cost Alternative to Propofol in Transcatheter Aortic Valve Replacement, With Equivalent In-Hospital and 30-Day Outcomes

Kronfli, Anthony; Lehman, Erik; Yamane, Kentaro; Roberts, S. Michael; Cios, Theodore J.

doi:10.1053/j.jvca.2020.08.039

Cited by 10 publications

(8 citation statements)

References 29 publications

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“…The hemodynamic effects of propofol during TAVR compared to other sedative drugs has been examined before. [ 19 20 21 22 23 24 ] The drug was generally safe specially when smaller dose is used. For example, propofol and dexmedetomidine were compared in two studies in TAVR patients, with no significant differences in intraoperative use of vasoactive drugs, in-hospital outcomes, and 30-day outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…For example, propofol and dexmedetomidine were compared in two studies in TAVR patients, with no significant differences in intraoperative use of vasoactive drugs, in-hospital outcomes, and 30-day outcomes. [ 19 21 ] On the contrary, propofol in a relatively higher dose and with a concomitant infusion of remifentanil or fentanyl boluses was associated with higher catecholamine use compared with dexmedetomidine in TAVR patients. [ 22 ] Similarly, propofol infusion in quite high dose required more vasopressors than remifentanil infusion in TAVR patients.…”

Section: Discussionmentioning

confidence: 99%

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The association between different anesthetic techniques and outcomes in patients undergoing transfemoral aortic valve replacement

Abuzaid,

AbdelAal,

Galal

2024

Saudi Journal of Anaesthesia

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Background: There is an increasing number of patients undergoing transfemoral aortic valve replacement (TAVR) with sedation. There is limited data assessing the efficacy and safety of the different types of sedative drugs. The objective was to compare two sedation techniques with regard to the need for vasoactive support, respiratory support, rate of conversion to general anesthesia (GA), common perioperative morbidities, intensive care unit (ICU) stay, and in-hospital mortality. Methods: A retrospective chart review study conducted among patients who underwent TAVR at a specialized cardiac center between January 2016 and December 2019. Data collection included patient diagnosis, preoperative comorbidities, intraoperative outcomes, and postoperative outcomes. Results: A total of 289 patients received local anesthesia; 210 received propofol infusion and 79 received a mixed propofol-ketamine infusion (Ketofol). The average age was 75.5 ± 8.9 years and 58.1% of the patients were females. Comparing propofol and ketofol groups, 31.2% and 34.2% of the patients required drug support, 7.6% and 6.3% required conversion to GA, 46.7% and 59.5% required respiratory support, respectively. These intraoperative outcomes were not significantly different between groups, P = 0.540, P = 0.707, and P = 0.105, respectively. In-hospital 30-day mortality in propofol and ketofol groups were 1.9% and 3.8%, respectively, P = 0.396. In both groups, the median post-procedure coronary care unit stay was 26 hours while post-procedure hospital stay was 3 days. Conclusions: There were no significant differences in perioperative or postoperative outcomes in TAVR patients receiving either propofol or ketofol. Propofol infusion, either alone or with ketamine, is reliable and safe, with minimal side effects.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The association between different anesthetic techniques and outcomes in patients undergoing transfemoral aortic valve replacement

Abuzaid,

AbdelAal,

Galal

2024

Saudi Journal of Anaesthesia

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“…In this context, Kronfli et al reported in this issue of the Journal their retrospective cohort study evaluating both outcomes and cost of TAVR. 10 All patients received monitored anesthesia care with either dexmedetomidine or propofol. The authors undertook this single-institution study because research has suggested improved outcomes associated with dexmedetomidine in traditional cardiac surgery compared with propofol, including a shorter time to extubation and ICU and hospital lengths of stay.…”

Section: The Economics Of Transcatheter Aortic Valvementioning

confidence: 99%

The Economics of Transcatheter Aortic Valve Replacement and the Anesthesiologist

Neuburger

Rong

2021

Journal of Cardiothoracic and Vascular Anesthesia

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“…In addition, Sanders et al [34] demonstrated that MAC is possible for the transcaval approach to TAVR, and recommended its use over general anaesthesia. Various sedation regimens have also been investigated, with both propofol and dexmedetomidine administration revealing no difference in major complications, in-hospital mortality, vasopressor requirements or cost [35].…”

Section: Transcatheter Aortic Valve Replacementmentioning

confidence: 99%

Anaesthesia for minimally invasive cardiac procedures in the catheterization lab

Reid

Meineri

Riva

et al. 2021

Current Opinion in Anaesthesiology

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Purpose of reviewThe share of cardiac procedures performed in settings involving nonoperating room anaesthesia (NORA) continues to grow rapidly, and the number of publications related to anaesthetic techniques in cardiac catheterization laboratories is substantial. We aim to summarize the most recent evidence about outcomes related to type of anaesthetic in minimally invasive cardiac procedures. Recent findingsThe latest studies, primarily focused on transcatheter aortic valve replacement (TAVR) and transcatheter mitral valve repair (TMVr), demonstrate the need for reliable monitoring and appropriate training of the interdisciplinary teams involved in this high-risk NORA setting.

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Dexmedetomidine Is an Equal Cost Alternative to Propofol in Transcatheter Aortic Valve Replacement, With Equivalent In-Hospital and 30-Day Outcomes

Cited by 10 publications

References 29 publications

The association between different anesthetic techniques and outcomes in patients undergoing transfemoral aortic valve replacement

The association between different anesthetic techniques and outcomes in patients undergoing transfemoral aortic valve replacement

The Economics of Transcatheter Aortic Valve Replacement and the Anesthesiologist

Anaesthesia for minimally invasive cardiac procedures in the catheterization lab

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