Predictors for Sedation Failure in Mitral Transcatheter Edge-to-Edge Repair Procedures

Background: Mitral transcatheter-edge-to-edge-repair (M-TEER) is mostly done with using general anesthesia (GA). Limited data including specific risk factors exist for a deep sedation (DS) approach.

Methods and Results: 464 M-TEER procedures were included for comparison of a DS approach versus those who required a conversion to GA. Specific predefined risk factors were analyzed to identify those patients who might not benefit from a DS strategy by the need of conversion to GA. The conversion rate from DS to GA was 6.7% (n = 433 successful DS and n = 31 conversion to GA). Mean age was 80 years. Classical surgical risk scores did not show any significant difference between the two groups. Patients with DS had a higher procedural success rate (96.1% versus 80.1%; p < 0.001). The time on the intensive care unit (ICU) (3.9 h versus 126 h; p = 0.023) was shorter for patients with DS. Patients who were in the need for a conversion to GA had a lower 30-day and 1-year survival rate. A multivariate analysis for conversion to GA showed body mass index (p = 0.023), pre-existing kidney failure (p < 0.001), obstructive sleep apnea syndrome (OSAS) (p = 0.031), systolic pulmonary pressure value (p = 0.013), and concomitant tricuspid regurgitation (p = 0.049) as risk factors.

Conclusions: Using DS in M-TEER is feasible with a low conversion rate to GA. In case of a conversion, the procedure is less successful regarding reduction of MR and more complications occurred with a lower survival rate up to 12 months. These data suggest that conversion from DS to GA is high risk. Therefore, we could identify different predictors for the need of a conversion to GA. However, our results could only be hypothesis-generated and should be evaluated in a randomized study.