Date of Award

January 2021

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Abeel A. Mangi

Abstract

Conscious Sedation (CS) has become a mainstay option for anesthesia in Transcatheter Aortic Valve Replacement (TAVR), but there has been limited investigation into the effect of CS medication choice on patient outcomes. This study aimed to assess whether the CS medications used in TAVR were associated with primary outcomes, including hospital length of stay (LOS), mortality, or need for post-operative permanent pacemaker. This retrospective, observational study included 272 patients who underwent TAVR with CS at a tertiary teaching hospital between September 2014 and December 2017. Patient and procedure data were collected from the STS/ACC Transcatheter Valve Therapy Registry and chart review. Patients were grouped according to the CS medications they received during TAVR, and three analyses were conducted from the pool of 272 patients: Propofol versus No propofol (n=203 vs. n=64), Propofol plus midazolam versus Propofol only (n=70 vs. n=94), and Dexmedetomidine versus No dexmedetomidine (n=86 vs. n=186). Several patient and procedure characteristics differed significantly at baseline in all three analyses. Regression and Cox proportional hazard analyses were conducted to adjust for differences. After adjustment, primary outcomes were not significantly different in each analysis, and there were no differences in secondary outcomes, including in-hospital death, discharge location, creatinine change, hemoglobin change, discharge creatinine, and incidence of blood transfusion. Among patients with prolonged LOS, more patients in the Propofol plus midazolam group had hypotension as a causative factor compared to the Propofol only group (56% versus 17%, p = 0.075), even though the Propofol plus midazolam group was younger and less ill. Ultimately, it is unclear whether CS medication choice for TAVR affects patient outcomes, and it is possible that medication selection can be left to provider preference. Further analysis with larger sample sizes may be warranted, especially to study the effect of propofol plus midazolam compared to single-sedative regimens.

Comments

This is an Open Access Thesis.

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