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Con: General Anesthesia Should No Longer Routinely Be Used for Transfemoral Transcatheter Aortic Valve Replacement

Published:December 22, 2022DOI:https://doi.org/10.1053/j.jvca.2022.12.017
      Transcatheter aortic valve replacement (TAVR) procedures were introduced in the early 2000s as an alternative to surgical aortic valve replacement (SAVR) in high-risk patients who were not surgical candidates.
      • Bourantas CV
      • Serruys PW.
      Evolution of transcatheter aortic valve replacement.
      The safety of the procedure improved over time as the procedure became more widespread and new deployment devices, valves, and percutaneous access were refined.
      • Bourantas CV
      • Serruys PW.
      Evolution of transcatheter aortic valve replacement.
      Encouraging outcomes, such as a decreased hospital length of stay and improved morbidity, have expanded access to TAVRs to populations deemed intermediate and low-risk for SAVR.
      • Carroll JD
      • Mack MJ
      • Vemulapalli S
      • et al.
      STS-ACC TVT Registry of transcatheter aortic valve replacement.
      According to the Society of Thoracic Surgery-American College of Cardiology Transcatheter Valve Therapy Registry, >70,000 TAVRs were performed in the United States in 2019, surpassing the number of SAVRs that year.
      • Carroll JD
      • Mack MJ
      • Vemulapalli S
      • et al.
      STS-ACC TVT Registry of transcatheter aortic valve replacement.
      The most common access site is increasingly transfemoral (95% in 2019), and the need for conversion to open cardiac surgery with the use of cardiopulmonary bypass has significantly decreased from 4% to 0.4% since the introduction of TAVRs.
      • Carroll JD
      • Mack MJ
      • Vemulapalli S
      • et al.
      STS-ACC TVT Registry of transcatheter aortic valve replacement.
      The focus of care surrounding TAVRs is now shifting to a minimally invasive approach with shorter procedure time, shorter hospital length of stay, and reduced costs.
      • Sawan MA
      • Calhoun AE
      • Grubb KJ
      • et al.
      Update on minimalist TAVR care pathways: Approaches to care in 2022.
      Although both conscious sedation and general anesthesia techniques can be used for TAVR procedures, the authors assert that conscious sedation is superior as it helps achieve these goals with potentially less risk.
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