Date of Award

8-8-2026

Document Type

Capstone

Degree Name

Doctor of Nursing Practice (DNP)

School Name

Donna and Allan Lansing School of Nursing and Health Sciences

Department

Nursing

Major Advisor

Dr. Carly Mitchell

Abstract

Abstract 

Background and Purpose: Transcatheter aortic valve replacement (TAVR) is increasingly performed under monitored anesthesia care (MAC) to facilitate faster recovery and reduce complications associated with general anesthesia. Standard oxygen therapy (SOT) may be insufficient in maintaining adequate oxygenation in this high-risk population. High-flow nasal cannula (HFNC) therapy has emerged as a potential alternative. This literature review evaluates the effects of HFNC compared with SOT on perioperative outcomes in patients undergoing TAVR under MAC. 

Methods: A comprehensive review of the literature was conducted to identify studies evaluating HFNC versus SOT during TAVR procedures performed under MAC. Six studies met inclusion criteria, including randomized controlled trials, meta-analyses, and retrospective studies. Studies were appraised using the Johns Hopkins Research Evidence Appraisal Tool, with evidence levels ranging from II to IV and overall good methodological quality. Outcomes of interest included incidence of hypoxemia and desaturation episodes, unplanned airway interventions, patient comfort, ICU admission, hospital length of stay, and 30-day mortality.  

Results: Across procedural sedation and TAVR-specific studies, HFNC was consistently associated with reduced incidence of perioperative hypoxemia, fewer desaturation episodes, and decreased need for airway interventions compared with SOT. Several studies also demonstrated improved patient comfort and enhanced procedural feasibility when HFNC was used. However, available studies were not adequately powered to evaluate long-term outcomes such as ICU admission, hospital length of stay, and 30-day mortality.  

Conclusions: Current evidence suggests that HFNC improves oxygenation stability and may procedural safety during TAVR performed under MAC compared with SOT. While improvements in oxygenation, airway intervention rates, and patient comfort have been reported, further large-scale studies are needed to determine the impact of HFNC on broader patient-centered and long-term clinical outcomes. HFNC represents a promising strategy to optimize anesthetic management in high-risk TAVR patients.  

Keywords: Transcatheter Aortic Valve Replacement (TAVR), High-flow nasal cannula (HFNC), standard oxygen therapy (SOT)

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