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Can You Get a New Aortic Valve While Partly Awake? With TAVR, Yes.

November 02, 2019

Transcatheter aortic valve replacement (TAVR) is the popular technique for replacing a defective heart valve without open-heart surgery, and one Hartford HealthCare fellow found a way to make it even safer, more efficient, more effective and less costly.

Dr. Wassim Mosleh, a second-year University of Connecticut cardiology fellow working with the Heart & Vascular Institute at Hartford Hospital, recently won first prize from the Hartford County Medical Association Research Committee for research entitled “Propensity Matched Analysis Comparing Conscious Sedation Versus General Anesthesia in Transcatheter Aortic Value Implantation.” He was  recognized at the group’s annual meeting in October.

With the number of TAVR procedures jumping from just 5,000 a year in 2004 to more than 25,000 in 2018, Dr. Mosleh said providers have been investigating ways to improve outcomes for patients needing the interventional procedure.

Looking back at patient records from the last three years, he and his research team examined the results of patients given general anesthesia against those patients who were given conscious sedation, in which the patient is partly awake and can respond to verbal stimuli.

“With general anesthesia, where the person is essentially unconscious, they must be intubated which is associated with more hemodynamic instability and greater risk to them,” Dr. Mosleh said. “But we needed to be sure that conscious sedation is safe, has comparable short- and long-term results, is efficient and cost effective.”

The team’s research revealed that:

  • Conscious sedation is just as safe, if not safer, than general anesthesia with fewer vascular and bleeding complications.
  • There was no change in the effectiveness of the procedure based on the anesthesia approach used.
  • Patients were typically discharged a day earlier, had shorter stays in the intensive care unit and used less radiation dose and time during the procedure with conscious sedation.
  • Patients were more likely to be discharged to their home instead of a rehabilitation facility or another hospital.
  • The cost of procedures using conscious sedation was about 10 percent less than with general anesthesia.

“That’s a significant savings, especially for programs like Hartford Hospital’s where there are many TAVRs done each year,” Dr. Mosleh said.

As a result, he predicts providers will opt for conscious sedation when possible with their TAVR patients. He said the Hartford Hospital cardiology team already prefers that option and will encourage others to follow with the same.

“This research underscores our belief that TAVR can be performed with less risk to the patient if we can avoid general anesthesia,” added Dr. Raymond McKay, co-director of the Structural Heart Program at the Heart & Vascular Institute, who worked with Dr. Mosleh on the research.

For more information on TAVR at the Hartford HealthCare Heart & Vascular Institute, click here.