There is growing interest in “minimalist” transcatheter aortic valve implantation
(M-TAVI), performed with conscious sedation instead of general anesthesia (GA-TAVI).
We assessed the impact of M-TAVI on procedural efficiency, long-term safety, and quality
of life (QoL) in 477 patients with severe aortic stenosis (82 years, women 50%, STS
5.0), who underwent M-TAVI (n = 278) or GA-TAVI (n = 199). M-TAVI patients were less
likely to have NYHA Class ≥3, valve-in-valve TAVI, and receive self-expanding valves.
M-TAVI was completed without conversion to GA in 269 (97%) patients. M-TAVI was more
efficient that GA-TAVI including shorter lengths of stay (2 vs 3 days, p <0.0001),
higher likelihood of being discharged home (87% vs 72%, p <0.0001), less use of blood
transfusions (10% vs 22%, p = 0.0008), inotropes (13% vs 32%, p <0.0001), contrast
volume (50 vs 90 ml, p <0.0001), fluoroscopy time (20 vs 24 minute, p <0.0001), and
need for >1 valves (0.4 vs 5.5%, p = 0.0004). At 1-month, death/stroke (M-TAVI vs
GA-TAVI 4.0 vs 6.5%) and a “safety composite” end point (death, stroke, transient
ischemic attack, myocardial infarction, new dialysis, major vascular complication,
major or life-threatening bleeding, and new pacemaker: 17.6% vs 21.1%) were similar
(p = NS for both). At a median follow-up of 365 days, survival curves showed similar
incidence of death/stroke as well as the safety composite end point between the groups.
QoL scores were similar at baseline and 1-month after TAVI. In multivariable analyses,
M-TAVI showed significant improvements in all parameters of procedural efficiency.
In conclusion, M-TAVI is more efficient than GA-TAVI, with similar safety at 1-month
and long-term, and similar QoL scores at 1 month.
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Article info
Publication history
Published online: January 08, 2020
Received in revised form:
January 3,
2020
Received:
November 3,
2019
Footnotes
Sources of funding: Support for statistical analysis was provided by an internal grant from Geisinger Health System.
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
