Anesthesia Types for TAVR

GW
CJ
RM
HN
Overseen ByHaley Nitchie
Age: 18+
Sex: Any
Trial Phase: Academic
Sponsor: Medical University of South Carolina
No Placebo GroupAll trial participants will receive the active study treatment (no placebo)

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how two types of anesthesia affect recovery in individuals undergoing Transcatheter Aortic Valve Replacement (TAVR) for aortic valve stenosis, a condition where the heart's aortic valve doesn't open fully. Participants will receive either monitored anesthesia care (MAC) or general endotracheal anesthesia (GETA). The study examines hospital stay length, ICU admission rates, and procedure success. Adults undergoing TAVR for aortic valve stenosis who can safely receive both types of anesthesia may qualify. As an unphased trial, this study allows participants to contribute to valuable research that could enhance anesthesia practices for future patients.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What prior data suggests that these anesthesia methods are safe for TAVR patients?

Research has shown that both General Endotracheal Anesthesia (GETA) and Monitored Anesthesia Care (MAC) are generally safe for patients undergoing Transcatheter Aortic Valve Replacement (TAVR). Studies suggest that MAC might offer some advantages over GETA. Specifically, MAC has been linked to a lower risk of death within 30 days and one year after the procedure, and it may also lead to shorter hospital stays.

GETA, a more traditional method, has been used in many procedures and is considered safe. However, some studies indicate that MAC could result in better outcomes for TAVR patients. Both methods are usually well-tolerated, with serious side effects being rare. Prospective trial participants should consult a healthcare provider to determine the best option.12345

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores different anesthesia techniques for patients undergoing Transcatheter Aortic Valve Replacement (TAVR). Unlike the traditional use of general endotracheal anesthesia, this trial considers monitored anesthesia care, which may offer a less invasive option with potentially quicker recovery times. By comparing these two methods, researchers hope to find out if monitored anesthesia care can provide similar or better outcomes with fewer side effects, ultimately enhancing patient comfort and safety during TAVR procedures.

What evidence suggests that this trial's anesthesia types could be effective for TAVR?

Research has shown that monitored anesthesia care (MAC), one of the anesthesia options in this trial, can be more beneficial during transcatheter aortic valve replacement (TAVR). Studies have found that patients receiving MAC have a lower risk of dying within 30 days, experience less kidney damage, and have fewer bleeding problems compared to those receiving general endotracheal anesthesia (GETA), the other anesthesia option in this trial. Patients with MAC also tend to spend less time in the hospital and have shorter procedures. Although GETA is commonly used in many surgeries, evidence suggests it may not offer the same benefits for TAVR as MAC does. Overall, MAC appears to lead to better outcomes for TAVR patients.14567

Who Is on the Research Team?

GW

George Whitener, MD

Principal Investigator

Medical University of South Carolina - Department of Anesthesia

Are You a Good Fit for This Trial?

Adults over 18 needing a TAVR for aortic valve stenosis and can receive both general anesthesia (GA) and monitored anesthesia care (MAC). Excluded are those who don't speak English, have BMI >37, difficult airways, pregnant women, unable to consent, allergic or with contraindications to the anesthetics or TEE.

Inclusion Criteria

I am an adult getting a valve replacement through my thigh for a narrowed heart valve.
I can safely receive general and monitored anesthesia care.

Exclusion Criteria

I cannot lie flat.
Inability or unwillingness of subject to give informed consent based on any reason
I do not have conditions like esophageal issues or active upper GI bleeding that prevent TEE.
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Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo Transcatheter Aortic Valve Replacement (TAVR) with either monitored anesthesia care (MAC) or general endotracheal anesthesia (GETA)

1 day
1 visit (in-person)

Immediate Post-operative Monitoring

Participants are monitored for ICU admission and procedural mortality

Up to 48 hours

Follow-up

Participants are monitored for safety and effectiveness after treatment, including paravalvular regurgitation assessment

1 year
2 visits (in-person)

What Are the Treatments Tested in This Trial?

Interventions

  • General Endotracheal Anesthesia
  • Monitored anesthesia care
Trial Overview The study compares two types of anesthesia in patients undergoing TAVR: MAC versus GA. It looks at hospital stay length, ICU admission rates, procedural mortality and if using TEE during GA affects device success.
How Is the Trial Designed?
2Treatment groups
Active Control
Group I: SedationActive Control1 Intervention
Group II: GeneralActive Control1 Intervention

General Endotracheal Anesthesia is already approved in European Union, United States, Canada, Japan, China, Switzerland for the following indications:

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Approved in European Union as General Anesthesia for:
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Approved in United States as General Anesthesia for:
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Approved in Canada as General Anesthesia for:
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Approved in Japan as General Anesthesia for:
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Approved in China as General Anesthesia for:
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Approved in Switzerland as General Anesthesia for:

Find a Clinic Near You

Who Is Running the Clinical Trial?

Medical University of South Carolina

Lead Sponsor

Trials
994
Recruited
7,408,000+

Published Research Related to This Trial

In a study of 998 patients undergoing transfemoral TAVR, monitored anesthesia care (MAC) was associated with significantly shorter procedural and fluoroscopy times, lower contrast volume, and reduced radiation exposure compared to general anesthesia (GA).
Patients receiving MAC had lower 30-day mortality rates (0.5% vs. 2.9%) and shorter ICU and hospital stays, indicating that MAC can improve efficiency and outcomes without compromising safety during TAVR procedures.
Comparing outcomes of general anesthesia and monitored anesthesia care during transcatheter aortic valve replacement: The Cleveland Clinic Foundation experience.Sammour, Y., Kerrigan, J., Banerjee, K., et al.[2022]
In a study of 93 patients undergoing transfemoral aortic valve replacements (TAVRs) with monitored anesthesia care (MAC), the choice of anesthetic agents, particularly propofol and dexmedetomidine, did not show significant differences in postoperative outcomes such as delirium or length of hospital stay.
Despite recommendations to adjust anesthetic doses for older patients, the study found no significant trends in dose reductions with increasing age, suggesting that current practices may not adequately account for age-related changes in drug metabolism.
A Pilot Analysis of the Association Between Types of Monitored Anesthesia Care Drugs and Outcomes in Transfemoral Aortic Valve Replacement Performed Without General Anesthesia.Chen, EY., Sukumar, N., Dai, F., et al.[2019]
In a systematic review of 1,542 patients undergoing Transcatheter Aortic Valve Implantation (TAVR), local anesthesia with monitored anesthesia care (MAC) was found to be as safe as general anesthesia (GA), with no significant differences in 30-day mortality or cardiac-related complications.
Patients receiving MAC experienced shorter procedure times and reduced hospital stays compared to those under GA, suggesting potential benefits in efficiency and recovery, although further randomized trials are needed to confirm these findings.
Local versus general anesthesia for transcatheter aortic valve implantation (TAVR)--systematic review and meta-analysis.Fröhlich, GM., Lansky, AJ., Webb, J., et al.[2022]

Citations

Sedation versus general anesthesia for transcatheter aortic ...There is currently significant controversy regarding the best anesthesia management for patients undergoing transcatheter aortic valve replacement (TAVR).
Conscious sedation/monitored anesthesia care versus ...While TAVR was associated with a 26-31% reduction in odds of mortality compared to surgical aortic valve replacement in women, there was no difference in ...
Impact of Anesthesia Strategy and Valve Type on Clinical ...In intermediate- to high-risk patients undergoing transfemoral TAVR, newer-generation SEV and BEV as well as CS and GA showed similar clinical outcomes at 1 ...
Comparative Efficacy of Local and General Anesthesia for ...This meta-analysis aimed to compare the potential effects of local anesthesia (LA) and general anesthesia (GA) for transcatheter aortic valve implantation ( ...
Conscious Sedation Versus General Anesthesia for ...Clinical Perspective​​ Conscious sedation was associated with briefer length of stay and lower in-hospital and 30-day mortality than general ...
The Anesthesia Professional's Role in Patient Safety ...Recent data demonstrate MAC anesthesia provides a similar rate of procedural success when compared to general anesthesia; however, whether MAC anesthesia ...
A Systematic Review and Meta-AnalysisOur results suggested that LA strategies reduced hospital stay, operative time, fluoroscopy time, cardiovascular drug consumption, and major bleeding rates.
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