Thorac Cardiovasc Surg 2018; 66(S 01): S1-S110
DOI: 10.1055/s-0038-1627862
Oral Presentations
Sunday, February 18, 2018
DGTHG: New Transcatheter- and Hybrid-Techniques/Imaging
Georg Thieme Verlag KG Stuttgart · New York

Conscious Sedation versus General Anesthesia in Transcatheter Aortic Valve Implantation: Insights from the German Aortic Valve Registry

B. Fujita
1   Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
,
O. Husser
2   Klinik für Herz- und Kreislauferkrankungen, Technical University of Munich, München, Germany
,
C. Hengstenberg
2   Klinik für Herz- und Kreislauferkrankungen, Technical University of Munich, München, Germany
,
A. Beckmann
3   Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie, Berlin, Germany
,
H. Möllmann
4   St.-Johannes-Hospital Dortmund, Dortmund, Germany
,
T. Walther
5   Kerckhoff Klinik, Bad Nauheim, Germany
,
R. Bekeredjian
6   University of Heidelberg, Heidelberg, Germany
,
S. Bleiziffer
7   Klinik für Herz- und Gefäßchirurgie, Technical University of Munich, München, Germany
,
F.-W. Mohr
8   Heart Center, Leipzig, Germany
,
T. Bauer
9   University of Giessen, Gießen, Germany
,
S. Ensminger
1   Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
,
C. Frerker
10   Department of Cardiology, Asklepios Klinik St Georg, Hamburg, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
22 January 2018 (online)

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Objectives: The aim of this analysis was to compare outcomes after usage of conscious sedation (CS) and general anesthesia (GA) for transfemoral transcatheter aortic valve implantation (TF-TAVI) in Germany and assess their influence on short and 1-year outcomes.

Methods: A total of 16,543 patients who received transfemoral TAVI between 2011–2014 and consecutively enrolled in GARY were analyzed. Propensity score (PS) matching was utilized to account for differences in baseline characteristics.

Results: CS was used in 8121 patients (49%) while 8422 patients (51%) received GA. 66% of TF-TAVI under CS were performed in high volume centers. Independent predictors for the use of CS were age, STS score, ASA class, previous pacemaker, pulmonary hypertension, mean pressure gradient, the year of the procedure and the number of total cases per center. After 1:1 PS matching, 2624 patients per group remained. 30-day mortality was lower with CS compared with GA (2.8 versus 4.6%, p = 0.001) while 1-year mortality was similar (14.1 versus 15.5%, p = 0.13). Both groups did not differ statistically significantly in terms of procedural success (97.8 versus 97.8%, p > 0.99), paravalvular leak ≥2° (3.9 versus 4.9%, p = 0.13) and new pacemaker implantation (20.4 versus 20.8%, p = 0.71). The use of CS was associated with less device malposition (1.5 versus 2.7%, p = 0.003), conversion to sternotomy (0.3 versus 1.4%, p < 0.001) but more vascular complications (11.1 versus 8.6%, p = 0.003).

Conclusion: TF-TAVI under CS is safe and achieves improved 30 day mortality while 1 year mortality was similar as GA. The in-hospital course was similar between CS and GA with slightly less complications with CS.