Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jan;36(1):103-108.
doi: 10.1053/j.jvca.2021.04.038. Epub 2021 May 3.

Propofol Versus Remifentanil Sedation for Transcatheter Aortic Valve Replacement: A Single Academic Center Experience

Vivian Doan  1 , Yutong Liu  2 , Emily G Teeter  3 , Alan M Smeltz  3 , John P Vavalle  4 , Priya A Kumar  5 , Lavinia M Kolarczyk  3
Affiliations

Propofol Versus Remifentanil Sedation for Transcatheter Aortic Valve Replacement: A Single Academic Center Experience

Vivian Doan et al. J Cardiothorac Vasc Anesth. 2022 Jan.

Abstract

Objective: Comparison of remifentanil versus propofol for sedation during transcatheter aortic valve replacement (TAVR) procedures to analyze the risk of sedation-related hypoxemia and hypotension. Secondary outcomes included the rate of conversion to general anesthesia, procedure length, rate of intensive care unit (ICU) admission, ICU and hospital lengths of stay, and 30-day mortality.

Design: Retrospective cohort study.

Setting: A single tertiary teaching hospital.

Participants: Two hundred fifty-nine patients who had propofol or remifentanil sedation for TAVR between March 2017 and March 2020.

Intervention: None.

Measurements and main results: There were 130 patients (50.2%) in the propofol cohort and 129 patients (49.8%) in the remifentanil cohort. The primary outcomes were oxygen saturation nadir values and vasopressor infusion use. Remifentanil was associated with a lower oxygen saturation nadir, as compared to propofol (91.3% v . 95.4%, p < 0.001). Risk factors associated with hypoxemia (defined as <92%) were body mass index (p = 0.0004), obstructive sleep apnea (p = 0.004), and remifentanil maintenance (p < 0.001). Vasopressor infusion use was significantly higher with propofol (64.9% v . 8.5%, p < 0.001). Propofol maintenance and angiotensin-converting enzyme inhibitor/angiotensin II receptor-blocker use were the only variables identified as risk factors for vasopressor use (p < 0.001 and p = 0.009).

Conclusions: For patients undergoing TAVR with conscious sedation, remifentanil was associated with more hypoxemia while propofol was associated with a higher rate of vasopressor use.

Keywords: aortic valve stenosis; conscious sedation; propofol; remifentanil; transcatheter aortic valve replacement.

PubMed Disclaimer

Conflict of interest statement

Declaration of interests

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Figure 1.
Figure 1.
Institutional trend in the use of propofol and remifentanil for conscious sedation for TAVRs from March 2017 to February 2020. Abbreviations: TAVR, transcatheter aortic valve replacement.
See this image and copyright information in PMC

References

    1. Mayr NP, Michel J, Bleiziffer S, et al.: Sedation or general anesthesia for transcatheter aortic valve implantation (TAVI). J Thorac Dis 7:1518–26, 2015 - PMC - PubMed
    1. Miles LF, Joshi KR, Ogilvie EH, et al.: General anaesthesia vs. conscious sedation for transfemoral aortic valve implantation: a single UK centre before-and-after study. Anaesthesia 71:892–900, 2016 - PubMed
    1. D’Errigo P, Ranucci M, Covello RD, et al.: Outcome after general anesthesia versus monitored anesthesia care in transfemoral transcatheter aortic valve replacement. J. Cardiothorac. Vasc. Anesth. 30:1238–43, 2016 - PubMed
    1. Butala NM, Chung M, Secemsky EA, et al.: Conscious sedation versus general anesthesia for transcatheter aortic valve replacement: variation in practice and outcomes. JACC Cardiovasc. Interv. 13:1277–87, 2020 - PMC - PubMed
    1. Hyman MC, Vemulapalli S, Szeto WY, et al.: Conscious Sedation Versus General Anesthesia for Transcatheter Aortic Valve Replacement: Insights from the National Cardiovascular Data Registry Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. Circulation 136:2132–40, 2017 - PubMed