Towards minimally invasiveness: Transcatheter aortic valve implantation under local analgesia exclusively

Abstract

The Transcatheter Aortic Valve Implantation (TAVI) program started in most centers using general anesthesia (GA) and monitoring of patients similar to high-risk surgical aortic valve replacement. After the initial experience, few centers preferred sedation with local anesthesia (LA) [ [1] Durand E. Borz B. Godin M. et al. Transfemoral aortic valve replacement with the Edwards SAPIEN and Edwards SAPIEN XT prosthesis using exclusively local anesthesia and fluoroscopic guidance: feasibility and 30-day outcomes. JACC Cardiovasc Interv. May 2012; 5: 461-467 Abstract Full Text Full Text PDF PubMed Scopus (142) Google Scholar ]. Currently both GA and LA with or without sedation are options for periprocedural anesthetic management of TAVI. Whether LA is superior to GA has not been addressed in randomized trials and no consensus upon the preferable method has been reached yet [ 2 Ruggeri L. Gerli C. Franco A. et al. Anesthetic management for percutaneous aortic valve implantation: an overview of worldwide experiences. HSR Proc Intensive Care Cardiovasc Anesth. 2012; 4: 40-46 PubMed Google Scholar , 3 Rex S. Anesthesia for transcatheter aortic valve implantation: an update. Curr Opin Anaesthesiol. 2013 Aug; 26: 456-466 Crossref PubMed Scopus (19) Google Scholar ]. We report the safety and feasibility of TAVI under LA and provide our own experience in the largest cohort so far reported.