Can You Get a New Aortic Valve While Partly Awake? With TAVR, Yes.

TAVR
Print icon

Transcatheter aortic valve replacement (TAVR) is the popular technique for replacing a defective heart valve without open-heart surgery, and one Hartford HealthCare fellow found a way to make it even safer, more efficient, more effective and less costly.

Dr. Wassim Mosleh, a second-year University of Connecticut cardiology fellow working with the Heart & Vascular Institute at Hartford Hospital, recently won first prize from the Hartford County Medical Association Research Committee for research entitled “Propensity Matched Analysis Comparing Conscious Sedation Versus General Anesthesia in Transcatheter Aortic Value Implantation.” He will be recognized at the group’s annual meeting later this month.

With the number of TAVR procedures jumping from just 5,000 a year in 2004 to more than 25,000 in 2018, Dr. Mosleh said providers have been investigating ways to improve outcomes for patients needing the interventional procedure.

Looking back at patient records from the last three years, he and his research team examined the results of patients given general anesthesia against those patients who were given conscious sedation, in which the patient is partly awake and can respond to verbal stimuli.

“With general anesthesia, where the person is essentially unconscious, they must be intubated which is associated with more hemodynamic instability and greater risk to them,” Dr. Mosleh said. “But we needed to be sure that conscious sedation is safe, has comparable short- and long-term results, is efficient and cost effective.”

The team’s research revealed that:

  • Conscious sedation is just as safe, if not safer, than general anesthesia with fewer vascular and bleeding complications.
  • There was no change in the effectiveness of the procedure based on the anesthesia approach used.
  • Patients were typically discharged a day earlier, had shorter stays in the intensive care unit and used less radiation dose and time during the procedure with conscious sedation.
  • Patients were more likely to be discharged to their home instead of a rehabilitation facility or another hospital.
  • The cost of procedures using conscious sedation was about 10 percent less than with general anesthesia.

“That’s a significant savings, especially for programs like Hartford Hospital’s where there are many TAVRs done each year,” Dr. Mosleh said.

As a result, he predicts providers will opt for conscious sedation when possible with their TAVR patients. He said the Hartford Hospital cardiology team already prefers that option and will encourage others to follow with the same.

“This research underscores our belief that TAVR can be performed with less risk to the patient if we can avoid general anesthesia,” added Dr. Raymond McKay, co-director of the Structural Heart Program at the Heart & Vascular Institute, who worked with Dr. Mosleh on the research.

For more information on TAVR at the Hartford HealthCare Heart & Vascular Institute, click here.

 


What's New

Diabetes and Winter

Diabetes? Follow This Doctor’s Cold-Weather Tips to Protect Feet

By Dr. Mark Tramontozzi For people with diabetes, the winter months are a time when more attention than usual should be given to the feet.  Diabetics are at risk for having reduced blood flow to the lower extremities, and the cold weather compounds this problem. The dry weather from being...

Brain Tumor

Neuro-Oncologist: Here’s How We Treat Brain Tumors

By Dr. Ahmad Daher Medical Director, Neuro-Oncology Hartford HealthCare Medical Group Patients with gliomas, the most common cancerous brain tumors, have shown only a modest improvement in survival rate despite diagnostic and therapeutic — surgery, radiation and pharmacotherapy — advancements in oncology over the last three decades. Here’s a summary of...

Graduating into College Sports

Graduating From High School to College Sports? Some Tips

Making the transition from high school to collegiate athletics can be a daunting and difficult task. Physical therapist Stefanie Bourassa and psychologist Peter Lucchio of the Hartford HealthCare Bone & Joint Institute’s Center for Musculoskeletal Health have several tips to help make this transition smooth. Bourassa, who played Division I...

Mako

Robot-Assisted Hip, Knee Replacements Now at Central Connecticut, MidState

In early November, The Hospital of Central Connecticut and MidState Medical Center each received a Mako robot that changes the approach to hip and knee replacement surgeries. Two colleagues, Dr. Richard Scarlett, Chief of Orthopaedics at The Hospital of Central Connecticut, and Dr. Stephen Nelson, a surgeon with the Connecticut...

Palliative vs. Hospice Care

What’s the Difference Between Hospice and Palliative Care?

November is National Hospice and Palliative Care Month and the team from Hartford HealthCare at Home wants to help those in need of these services make the right decisions during what is a critical time for them and their loved ones. Hospice and palliative care offer compassionate care to patients...


Syrian Refugee Travels Long Road to Freedom (and Windham Hospital)

Ayman Al Hariri has started a new life in Willimantic and at Windham Hospital. The Syrian refugee, a former middle school teacher in his native land, left the war-torn nation more than four years ago for the safety of his wife and two young children.  The United Nations estimates that...