The Evolution of Echocardiographic Type and Anesthetic Technique for Transcatheter Aortic Valve Replacement at a High-Volume Transcatheter Aortic Valve Replacement Center.

OBJECTIVE: Describe the change in intraoperative transcatheter aortic valve replacement (TAVR) care by examining the utilization of transesophageal echocardiography (TEE) versus transthoracic echocardiography (TTE) and general anesthesia (GA) versus conscious sedation (CS) over time. DESIGN: Retrospective, observational. SETTING: A university, single, high-volume TAVR center. PARTICIPANTS: Patients who underwent TAVR. INTERVENTIONS: Retrospective data collection from the electronic medical records on TAVR patients at a single institution from March 1, 2014 to August 31, 2017. The intraoperative echocardiographic modality, anesthetic type, Society of Thoracic Surgeons (STS) operative mortality risk score, and date each new TAVR valve first was employed at the institution were recorded. MEASUREMENTS AND MAIN RESULTS: Data were analyzed using descriptive statistics apportioned into 6-month intervals. The Fisher exact test and chi-square test were used to test the association of anesthesia type and echocardiography over time, respectively. STS score, anesthetic type, and echocardiographic type were compared using the Wilcoxon rank sum test. Analysis showed increased use of TTE and CS, from 0% and 0% intially to 68.42% and 63.16% most recently (p < 0.0001). In the final study period (after March 1, 2017), the use of TTE and CS surpassed TEE and GA, respectively. STS scores were significantly higher among patients having TEE versus TTE (median STS 6.34 v 4.45, respectively [p = 0.0047]) and GA versus CS (median STS 6.36 v 4.37, respectively [p = 0.0090]). CONCLUSION: Although TAVR initially was conducted exclusively under GA with TEE, nearly two-thirds of TAVR procedures now are performed using CS and TTE at the authors' institution. STS scores were significantly lower in patients having CS and TTE.