Poster Presentation: Deep Sedation with Natural Airway is a Viable Alternative to General Anesthesia with Endotracheal Tube for Isolated Transcatheter Pulmonary Valve Implantation-Deep Sedation with Natural Airway is a Viable Alternative to General Anesthesia with Endotracheal Tube for Isolated Transcatheter Pulmonary Valve Implantation

Deep Sedation with Natural Airway is a Viable Alternative to General Anesthesia with Endotracheal Tube for Isolated Transcatheter Pulmonary Valve Implantation

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This study conducted by the Mayo Foundation for Medical Education and Research aimed to compare outcomes between Transcatheter Pulmonary Valve Implantation (TPVI) patients who received either deep sedation with a natural airway or general anesthesia with endotracheal intubation (GETA) in a large medical center's cardiac catheterization lab. It encompassed a retrospective chart review of 85 patients from May 2018 to March 2023.<br /><br />The study found that the sedation group experienced significantly fewer complications (14.7% vs. 41.2%, p=0.015) and shorter procedure times (140.1 vs. 178.2 minutes, p=0.011) compared to the GETA group. Additionally, anesthesia times were markedly lower in the sedation group (201.8 vs. 256.6 minutes, p=0.001), and these patients also required fewer vasoactive medications (p=0.002). The length of stay in the hospital was shorter for the sedation group with fewer admissions to the ICU (47.1% vs. 74.5%, p=0.016).<br /><br />Both groups were found to be similar in other demographic factors such as weight, sex, race, ASA status, and right ventricular systolic pressure (RVSP). The average age was higher in the sedation group (36.8 vs. 27.0 years, p=0.002). Adjustments for age in a multivariable analysis confirmed that the higher complication rate in the GETA group was not due to providers choosing GETA for higher acuity patients.<br /><br />The study suggests that deep sedation with a natural airway is a viable and safer alternative to GETA for TPVI, associated with fewer complications and shorter procedural and hospitalization times. These results warrant further research to substantiate the findings and develop clearer anesthesia care guidelines for CHD patients undergoing TPVI procedures. The study, however, is limited by potential selection bias as the choice of anesthesia was left to provider preference.

Keywords

Transcatheter Pulmonary Valve Implantation

deep sedation

general anesthesia

complications

procedure times

anesthesia times

vasoactive medications

ICU admissions

demographic factors

retrospective chart review