Background: Transcatheter aortic valve replacement (TAVR) is a rapidly developing procedure for patients with aortic stenosis. Initially designed for only those of high risk who were thought to be unable to undergo conventional surgery, recent evidence has expanded its utility for patients of intermediate risk. As the TAVR procedure gains efficacy in the United States both the total number of procedures as well as sites is rapidly increasing. Along with this rapid change in case volume so too is the anesthetic and post-procedure management of these cases across the world. General Anesthesia (GA), Monitored Anesthesia Care (MAC), and Local Anesthesia (LA) have all been demonstrated. This study seeks to evaluate the current state of anesthesia management and monitoring as well as post-procedure management across all TAVR centers in the United States.
Methods: The study is an ongoing nonrandomized survey of all TAVR centers in the United States. TAVR centers were discovered via online searches and use of www.newheartvalve.com. After IRB approval, each center was contacted to identify the contact that could answer questions regarding anesthesia and post-procedure management and the survey was distributed electronically via Qualtrics (Provo, Utah) survey system. Each center was asked the same questions regarding anesthesia and post-procedure management.
Results. Preliminary results show that GA is practiced on average 51 %, MAC is practiced on average 48%, and no center currently has described the use of LA. Medication regimens for MAC seem to vary across centers. Transthoracic echocardiography is used frequently for MAC cases. Current data suggests that patients are sent to the ICU after the procedure and most patients remain in the hospital for less than 72 hours. More centers use peripheral venous access then central or pulmonary arterial catheter and radial artery catheters are most often used without cardiac output monitoring for both MAC and GA techniques. Further details are listed in Table 1,
Conclusions: Preliminary data suggests that GA appears to be the predominant practice in the United States, however the use of MAC has risen from what has previously been reported in the United States. There also appears to be a large degree of variation regarding other management choices for patients undergoing TAVR. Future research should evaluate the potential utility of standardization strategies.
