Local Versus General Anesthesia in Transcatheter Aortic Valve Replacement

Area of Science:

• Cardiology
• Interventional Cardiology
• Anesthesiology

Background:

• Transcatheter aortic valve replacement (TAVR) is typically performed under general anesthesia (GA).
• Intraoperative transesophageal echocardiogram imaging is standard with GA.
• Alternative anesthesia methods are being explored to improve patient outcomes and resource utilization.

Purpose of the Study:

• To evaluate the safety and efficacy of TAVR performed under local anesthesia (LA).
• To compare the length of hospital stay for TAVR patients managed under LA versus GA.
• To assess the feasibility of transferring LA TAVR patients to a low-dependency unit post-procedure.

Main Methods:

• Retrospective analysis of transfemoral TAVR procedures conducted between January 2011.
• Comparison of patient outcomes between a group undergoing TAVR under GA (n=145) and a group under LA (n=71).
• Assessment of procedural time, 30-day adverse events (aortic regurgitation, permanent pacing, cerebrovascular accidents), 30-day survival, and hospital length of stay.

Main Results:

• The LA group had a significantly shorter procedure time (108 vs. 143 minutes, p < 0.001).
• No significant differences were observed in 30-day rates of moderate or severe aortic regurgitation, need for permanent pacing, or disabling cerebrovascular accidents between groups.
• The median hospital stay was significantly shorter in the LA group (2 days vs. 4 days, p < 0.001). 30-day survival was high in both groups (100% LA vs. 95.9% GA).

Conclusions:

• Performing TAVR under LA is a safe alternative to GA.
• LA TAVR is associated with reduced procedural time and shorter hospital stays.
• LA TAVR is a safe, cost-effective option, enabling transfer to low-dependency units post-procedure.