Comparison of Transthoracic Echocardiography (TTE) and Transesophageal Echocardiography (TEE) Guidance for Transcatheter Aortic Valve Replacement (TAVR) Performed Under Conscious Sedation: A Retrospective Study

Transcatheter aortic valve replacement (TAVR) is increasingly performed using long-acting sedation instead of general endotracheal anesthesia (GETA), offering benefits such as shorter procedure times, fewer complications, and quicker recovery. Intraoperative echocardiographic guidance is critical for procedural success, with transesophageal echocardiography (TEE) offering superior imaging quality compared to transthoracic echocardiography (TTE). However, TEE is less commonly used with long-acting sedation. This study assessed the feasibility and safety of TTE vs TEE in TAVRs under long-acting sedation. This retrospective observational study analyzed 60 TAVR cases performed at a quaternary care center, with 30 guided by TEE and 30 by TTE. All procedures were performed under long-acting sedation. Procedural metrics, imaging quality, and in-hospital outcomes were compared between groups. The two groups were similar in baseline characteristics. Procedure times did not significantly differ (TEE: 70.46 ± 36.59 minutes vs. TTE: 66.44 ± 25.51 minutes, p = 0.624). However, TEE provided significantly superior imaging quality (mean score 5.0 vs. 2.73 ± 0.83, p < 0.001). No significant increase in complications or need for escalation to GETA was observed in the TEE group. TEE can be safely and effectively used to guide TAVR under long-acting sedation, offering superior intraoperative imaging without prolonging procedure time or increasing risk. This approach supports the continued expansion of long-acting sedation-based TAVR protocols using TEE in appropriate patients.