ABSTRACT
Background: Monitored Anesthesia Care (MAC) has been
increasingly used in lieu of general anesthesia (GA) for transcatheter
aortic valve replacement (TAVR). We sought to compare outcomes and
in-hospital costs between MAC and GA for TAVR at a single center
Veterans Affairs Medical Center.
Methods: A single-center retrospective review of 349
patients who underwent TAVR (MAC, n = 244 vs. GA, n = 105) from January
2014 to December 2019 was performed. Baseline patient characteristics,
operating room (OR) time, intensive care unit (ICU) length of stay (LOS)
and cost, total LOS, hospital cost, total cost, and complication rates
were collected. Propensity matching was performed and resulted in 83
matched pairs.
Results: In the unmatched TAVR cohort, MAC TAVR was
associated with reduced OR time (146 vs. 198 minutes, P< .0001), ICU LOS (1.4 vs. 1.8 days, P <
0.0001), total hospital LOS (3.4 vs. 5.4 days, P <
.0001), and lower index total cost ($81,3000 vs. $85,400, P =
.010). After propensity matching, MAC TAVR patients had reduced OR time
(146 vs. 196 minutes, P < 0.05), ICU LOS (1.2 vs. 1.7
days, P = .006), total LOS (3.5 vs. 5.1 days, P = .001),
and 180-day mortality (2.4% vs. 12%, P < 0.03). There
was no difference in total hospitalization cost or total cost.
Conclusions: In propensity matched groups, TAVR
utilizing MAC is associated with improved OR time efficiency, decreased
LOS, and a reduction in 180-day mortality, but no significant difference
in cost.
Abstract Word Count: 256