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.
Monitored Anesthesia Care versus General Anesthesia for Transcatheter Aortic Valve Replacement
