Cost-Effectiveness of a Solo Anesthesiologist During Transcatheter Aortic Valve Replacement in Patients With Severe Comorbidities.

The present investigation evaluates risk factors and the timing of conversion to general anesthesia (GA) instead of conscious sedation (CS) for patients undergoing transcatheter aortic valve replacement (TAVR). The femoral artery approach to TAVR is primarily used for older patients with aortic stenosis. CS without an anesthesiologist involved in many situations is becoming the standard of care due to faster recovery, fewer complications, and lower costs, concurrent with easier placement of smaller new-generation valves. GA remains necessary for patients with specific health conditions that may complicate spontaneous breathing or trigger cardiovascular collapse. Emergent conversion to GA carries a 30% mortality rate. Consequently, monthly multidisciplinary planning meetings should include a cardiac anesthesiologist to identify risk factors that necessitate monitored anesthesia care (MAC) administered by the same solo physician, rather than CS administered by registered nurses under the direction of a cardiologist. These insights will help guide future pathways for triage of obstructive sleep apnea (OSA) and congestive heart failure (CHF), especially pulmonary hypertension, toward earlier therapies of pressure support noninvasive ventilation, gradual vasopressors, and sedatives titrated in addition to predominantly dexmedetomidine.