According to a new research from Germany, deep sedation is a comparable, safe alternative to general anesthesia for patients undergoing percutaneous mitral valve repair (PMVR) for mitral regurgitation. 

Deep sedation may simplify the PMVR procedure for patients who are often frail, have other illnesses, and experience severe heart failure.  The authors report the findings in Journal of the American Heart Association

"Transcatheter, percutaneous mitral valve repair can be performed safely and effectively with deep sedation, sparing the patient general anesthesia and speeding recovery," Dr. Marc Gillinov, chair of the Department of Cardiothoracic Surgery at Cleveland Clinic in Cleveland, Ohio reported. 

"Most transcatheter procedures can be done without general anesthesia, so this is a natural progression," said Dr. Gillinov, who was not involved in the study.

Senior authors Dr. Harald F. Langer and Dr. Peter Seizer et al. retrospectively reviewed medical records from 271 consecutive patients (mean age, 77) who had undergone PMVR using the MitraClip system (Abbott Vascular, Santa Clara, California) at their academic medical center from May 2014 to December 2016.

A team of cardiologists,  cardio-anesthesiologists, and cardiothoracic surgeons had determined that all of the patients were unsuitable for conventional surgical repair.

The 199 participants who underwent deep sedation group received a significantly lower mean dose of propofol than did the 72 patients who underwent general anesthesia (369 mg vs. 743 mg); the same was true for norepinephrine dosing (0.2 mg vs. 1.1 mg, respectively).

The deep-sedation group also had a significantly shorter mean procedure (129 vs. 139 minutes) and fluoroscopy (16 vs. 23 minutes) times; a significantly smaller dose area product (25 vs. 36 Gy/cm2); and less frequent need for a post-intervention ICU stay (19% vs. 96% of patients) – compared with the general anesthesia group.

The two groups had similar overall bleeding complications, post-intervention pneumonia incidence, and C-reactive protein levels – as well as similar rates of intrahospital and 6-month mortality.

"PMVR performed under deep sedation results in the reduction of mitral regurgitation similar to PMVR performed under general anesthesia. Performing PMVR under deep sedation reduces the need for catecholamines as well as postinterventional intensive care unit and overall hospital length of stay," the authors report, and they recommend further related research.