Outcomes of Non‐Anesthetist Led Conscious Sedation for 2000 Transcatheter Aortic Valve Implantations

Background A minimalist approach to transcatheter aortic valve replacement (TAVR) has accompanied the increase in TAVR procedures worldwide. Comprehensive evidence regarding the safety of non‐anesthetist‐led conscious sedation for TAVR is lacking. Aims We aimed to evaluate the outcomes of patients undergoing TAVR with non‐anesthetist‐led conscious sedation. Methods This retrospective analysis included consecutive patients who underwent percutaneous transfemoral TAVR with non‐anesthetist‐led conscious sedation, from March 2018 to 2025, in a single high‐volume center. Thirty‐day outcomes were assessed. Results Of 2854 patients who underwent TAVR, 2000 (70.1%) had non‐anesthetist‐led conscious sedation (age: 80.7 ± 6.5 years, 42.1% female). The annual proportion of non‐anesthetist‐led conscious sedation procedures increased from 37% (2018–2019) to 81% (2024–2025). Fentanyl was administered to 1986 (99.3%) patients (median: 75 mcg [IQR: 50–100]) and Midazolam to 945 (47.3%) patients (median: 1.5 mg [IQR: 1.0–2.0]). Mean procedural duration was 81.3 ± 67.7 min. Emergency anesthetic support was required for 53 (2.7%) patients, due to: vascular access complications ( n = 15), cardiac arrest ( n = 14), annular rupture/aortic dissection ( n = 9), profound hypotension ( n = 8), agitation ( n = 4), ventricular perforation ( n = 2) and reduced consciousness (stroke) ( n = 1). Conversion to general anesthesia was required for 24 (1.2%) patients. Emergency bail‐out surgery (cardiac/vascular) was undertaken in 15 patients (0.75%). Among the 2000 patients, 30‐day mortality was 1.3%, and VARC‐3 technical success, device success, and early safety were achieved in 97.2%, 92.7%, and 78.9% of patients, respectively. Conclusions Non‐anesthetist‐led conscious sedation can be delivered safely in most patients undergoing percutaneous transfemoral TAVR. The need for emergency anesthetic support is low.