Heather K Hayanga1, Kaitlin E Woods2, Dylan P Thibault3, Matthew B Ellison1, Roosevelt N Boh4, Bryan D Raybuck5, Partho P Sengupta5, Vinay Badhwar3, JW Awori Hayanga3
1 Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology, West Virginia University, United States
2 Department of Medical Education, West Virginia University, United States
3 Department of Cardiovascular and Thoracic Surgery, West Virginia University, United States
4 West Virginia University School of Medicine, United States
5 Department of Medicine, Division of Cardiology, West Virginia University, United States
Background: General anesthesia has traditionally been used in transcatheter aortic valve replacement; however, there has been increasing interest and momentum in alternative anesthetic techniques.
Aims: To perform a descriptive study of anesthetic management options in transcatheter aortic valve replacements in the United States, comparing trends in use of monitored anesthesia care versus general anesthesia.
Settings and Design: Data evaluated from the American Society of Anesthesiologists' (ASA) Anesthesia Quality Institute's National Anesthesia Clinical Outcomes Registry.
Materials and Methods: Multivariable logistic regression was used to identify predictors associated with use of monitored anesthesia care compared to general anesthesia.
Results: The use of monitored anesthesia care has increased from 1.8% of cases in 2013 to 25.2% in 2017 (p = 0.0001). Patients were more likely ages 80+ (66% vs. 61%; p = 0.0001), male (54% vs. 52%; p = 0.0001), ASA physical status > III (86% vs. 80%; p = 0.0001), cared for in the Northeast (38% vs. 22%; p = 0.0001), and residents in zip codes with higher median income ($63,382 vs. $55,311; p = 0.0001). Multivariable analysis revealed each one-year increase in age, every 50 procedures performed annually at a practice, and being male were associated with 3% (p = 0.0001), 33% (p = 0.012), and 16% (p = 0.026) increased odds of monitored anesthesia care, respectively. Centers in the Northeast were more likely to use monitored anesthesia care (all p < 0.005). Patients who underwent approaches other than percutaneous femoral arterial were less likely to receive monitored anesthesia care (adjusted odds ratios all < 0.51; all p = 0.0001).
Conclusion: Anesthetic type for transcatheter aortic valve replacements in the United States varies with age, sex, geography, volume of cases performed at a center, and procedural approach.
Heather K Hayanga
Division of Cardiovascular and Thoracic Anesthesiology, Heart and Vascular Institute, West Virginia University, 1 Medical Center Drive, Morgantown, WV 26505
Source of Support: None, Conflict of Interest: None
[FULL TEXT] [PDF]*