L. Mukdad1, W. Toppen1,3, K. Kim1, S. Barajas1, R. Shemin1, A. Mendelsohn2, P. Benharash1 1David Geffen School Of Medicine, University Of California At Los Angeles,Cardiac Surgery,Los Angeles, CA, USA 2David Geffen School Of Medicine, University Of California At Los Angeles,Head And Neck Surgery,Los Angeles, CA, USA 3David Geffen School Of Medicine, University Of California At Los Angeles,Internal Medicine,Los Angeles, CA, USA
Introduction: Transcatheter aortic valve replacement (TAVR) has become the preferred therapy for severe aortic stenosis in patients with high surgical risk. While general anesthesia has been the standard during these procedures, recent evidence suggests that a minimalistic approach utilizing conscious sedation may have similar if not improved clinical outcomes. The incidence and impact of post-TAVR dysphagia has yet to be fully elucidated. The purpose of this study was to compare the incidence of postoperative dysphagia and aspiration pneumonia in patients undergoing TAVR procedures with either conscious sedation (CS) or general anesthesia (GA).
Methods: This was a retrospective single center study involving all adult patients undergoing TAVR between September 2013 and May 2016. The diagnosis of postoperative dysphagia was confirmed by a fiberoptic endoscopic evaluation of swallowing test. Propensity score matching was used to control for intergroup differences and account for potential selection biases. The Society of Thoracic Surgeons predicted risk of mortality score, a previously validated composite risk stratification tool was used as our propensity score. Categorical variables were analyzed by Fisher’s exact test and continuous variables were analyzed by the independent sample T-test for unequal sample size. An alpha of < 0.05 was considered statistically significant. All data were analyzed using STATA 13.0 statistical software (StataCorp, College Station, TX).
Results: A total of 200 patients were included in this study (CS=58 and GA= 142). After propensity score matching and exclusion of unmatched patients, 187 patients remained (CS=58 and GA=129). There were no differences in baseline comorbidities between the matched groups (Table 1). Postoperative dysphagia was significantly higher in the GA group (0% CS vs 8% GA, p=0.03) with a trend towards more aspiration pneumonia in the GA group (0% CS vs 3% GA, p=0.31). Additionally, procedure room time (95 ± 44 min CS vs. 148 ± 109 min GA, p < 0.001), total ICU time (27 ± 32 h CS vs. 87 ± 98 h GA, p < 0.001), and total length of hospital stay (3 days CS vs. 7 days GA, p < 0.001) were significantly less in the conscious sedation TAVR group.
Conclusion: We found that the use of conscious sedation in TAVR was associated with a significant decrease in the incidence of postoperative dysphagia and a trend towards fewer instances of aspiration pneumonia. Additionally, CS was associated with lower operative times and shorter ICU and hospital length of stay at our institution. Given the increase in resource utilization with dysphagia, our results suggest significant improvements with the use of CS for TAVR procedures.
