0017 : Local versus general anesthesia for transfemoral aortic valve implantation: efficiency, safety, prognosis

Abstract

Transcatheter aortic valve replacement (TAVR) is quickly spreading as an efficient and safe therapy for the treatment of aortic valve stenosis in patients denied for surgery. There is no clear guideline established regarding anesthetic modalities to perform TAVR procedures. This study was designed to assess the superiority of the local anesthesia for transfemoral TAVR, regarding major adverse events occuring in the early postoperative time. From January 2014 to June 2015, 236 consecutive patients were included in the study (99 under general anesthesia [GA] and 137 under local anesthesia [LA]). The primary endpoint was a combination of MACE, rehospitalization for heart failure, acute kidney injury (AKI) stage 2 or 3, lifethreatening bleeding, major vascular complication, cardiac or rythmologic reintervention and/or haemodynamic instability, in the first 30 days after TAVR (each defined by VARC-2 criteria). Baseline characteristics were similar between the two groups. Conversion to general anesthesia occured in only 2 cases and procedural success was 94.9% (p=NS). The combined endpoint was reached in 45 GA patients and in 41 LA patients (p=0.02). We observed significantly less AKIevents in LA patients (9 vs 22; p<0.001), less rehospitalization (0 vs 4; p=0.02) and less vascular access site complications (15 vs 29; p<0.001). Postoperative echocardiographic results were similar in both groups. Secondary analysis revealed a shorter hospital stay (9±6.2 days vs 11.4±6.1 days; p=0.003) and shorter ICU stay (2.2±3.9 days vs 3.4±3.6 days; p=0.016) in LA patients.Fig. 1 Local anesthesia significantly reduced the incidence of major adverse events after transfemoral TAVR, especially AKI and vascular access site complications (main predictors of early death after TAVR), without any significant change in echocardiographic results or procedural success. The author hereby declares no conflict of interestDownload : Download full-size imagePrimary endpoint and echocardiographic results Primary endpoint and echocardiographic results