Comparative analysis of outcome and safety between conscious sedation and intubation general anesthe-sia in patients undergoing transcatheter aortic valve replacement

WangYipeng; Zhou Chenghui; Liu Daqi

doi:10.3969/j.issn.1674-4055.2024.05.06

Abstract：Objective To compare the outcomes and safety of patients undergoing transcatheter aortic valve replacement(TAVR)with conscious sedation and intubation general anesthesia.Methods A retrospective analysis was conducted on 104 patients with severe aortic stenosis(AS)who received TAVR treatment by the femoral artery at the AnesthesiaCenter of Beijing Anzhen Hospital Affiliated to Capital Medical University from March 2020 to May 2022.A retrospective analysis of 104 patients with severe aortic stenosis(AS)who were treated in the hospital with transfemoral TAVR between March 2020 and May 2022 was conducted.According to the method of anesthesia,all patients were divided into conscious sedation group and intubation anesthesia group.At 1,6,and 12 months after TAVR,patients'quality of life and self-care ability were assessed using the MOS item short fromhealth survey(SF-36)and the European five-dimension Health Scale(EuroQol-5D),as well as the Barthel Index Rating Scale.Perioperative outcomes included postoperative delirium(POD)incidence and length of stay in intensive care unit(ICU).Safety outcomes were defined as complex events involving death,stroke,transient ischemic attack,acute myocardial infarction,need for dialysis,major vascular complications,major or life-threatening bleeding,and the need for permanent pacemaker implantation.Results Compared with the intubation anesthesia group,the incidence of POD in the perioperative period of patients in the conscious sedation group was significantly reduced,and the length of ICU stay was significantly shortened,with statistical significance(P<0.05).There were no significant differences in SF-36 score,EuroQol-5D score and Barthel scale score between conscious sedation group and intubation anesthesia group(P>0.05).There was no significant difference in postoperative safety composite outcome between the two groups(P>0.05).Conclusion Compared to tracheal intubation general anesthesia,conscious sedation TAVR can reduce POD and ICU stay time without compromising safety and patient quality of life.TAVR under conscious sedation is a safe and effective surgical procedure for AS patients and an acceptable alternative to general anesthesia.