The Incidence of Dysphagia Among Patients Undergoing TAVR With Either General Anesthesia or Moderate Sedation

Laith Mukdad; Rustin Kashani; Aditya Mantha; Sohail Sareh; Abie Mendelsohn; Peyman Benharash

doi:10.1053/j.jvca.2018.05.040

The Incidence of Dysphagia Among Patients Undergoing TAVR With Either General Anesthesia or Moderate Sedation

J Cardiothorac Vasc Anesth. 2019 Jan;33(1):45-50. doi: 10.1053/j.jvca.2018.05.040. Epub 2018 May 26.

Authors

Laith Mukdad¹, Rustin Kashani¹, Aditya Mantha¹, Sohail Sareh¹, Abie Mendelsohn¹, Peyman Benharash²

Affiliations

¹ Division of Cardiac Surgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA.
² Division of Cardiac Surgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA. Electronic address: pbenharash@mednet.ucla.edu.

PMID: 30057252
DOI: 10.1053/j.jvca.2018.05.040

Abstract

Objectives: To determine the incidence of dysphagia and aspiration pneumonia following transcatheter aortic valve replacement (TAVR) performed with either general anesthesia (GA) or moderate sedation (MS).

Design: Retrospective study.

Setting: Tertiary care university hospital.

Participants: One hundred ninety-seven patients undergoing TAVR from 2012 to 2016 INTERVENTIONS: After Institutional Review Board approval, 197 consecutive patients undergoing TAVR from 2012 to 2016 at the authors' institution were identified for analysis and placed into groups depending on method of anesthesia received (GA: n = 139 v MS: n = 58). Groups then were compared with respect to baseline characteristics, operative details, primary outcome variables (dysphagia, pneumonia), and secondary outcome variables.

Measurement and main results: Any patient who failed the institution's postprocedure bedside swallow test subsequently underwent a fiberoptic endoscopic evaluation of swallowing test, confirming the diagnosis of dysphagia. GA patients were significantly more likely to develop dysphagia, which occurred in 10 GA patients and no MS patients (p = 0.04). MS patients also were found to have significantly reduced operative durations and spent less time in the intensive care unit and hospital (p < 0.001).

Conclusions: Patients who underwent TAVR with moderate sedation were less likely to develop dysphagia. Use of MS may be particularly suitable in patients predisposed to swallowing dysfunction.

Keywords: anesthesia; conscious sedation; dysphagia; outcomes; pneumonia; transcatheter aortic valve replacement.

MeSH terms

Aged, 80 and over
Anesthesia, General / methods*
Aortic Valve / surgery*
Aortic Valve Stenosis / complications
Aortic Valve Stenosis / surgery*
California / epidemiology
Conscious Sedation / methods*
Deglutition Disorders / complications
Deglutition Disorders / epidemiology*
Female
Humans
Incidence
Male
Postoperative Complications*
Retrospective Studies
Risk Factors
Transcatheter Aortic Valve Replacement / methods*