[DIFFERENT ANESTHESIA APPROACHES IN THE TRANSCATHETER AORTIC VALVE IMPLANTATION (TAVI) PROCEDURE AND THEIR POSSIBLE...

Transcatheter aortic valve implantation (TAVI) is used in patients with severe aortic stenosis (AS) who are at high surgical risk. Pre- and post-operative management is challenging as these patients are older, have significant comorbidities and a very high expected mortality rate in conventional surgery. There is no consensus in the literature about the preferred form of anesthesia, however, currently most centers perform the procedure using local anesthesia with sedation (LA-S).

To compare general anesthesia (GA) and LA-S in patients undergoing TAVI.

A retrospective review of the first 100 patients who underwent TAVI (11/2008-6/2011) at the Rabin Medical Center, due to severe and symptomatic AS and a counter-indication for conventional valve replacement surgery.

A total of 46 patients underwent the procedure with GA and 54 with LA-S. In 63 patients, the transfemoral approach was used, transapical in 23, and transaxillary in 11. There were no significant differences in short- and long-term mortality, but average hospitalization was longer in the GA group. A larger proportion of patients needed norepinephrine and blood transfusions during the procedure in the GA group. In the LA-S group, more conduction, vascular complications and postoperative fever were observed. In comparisons between anesthesia methods with the transfemoral approach, most of the differences lost their significance. Therefore, these differences are most likely attributed to the surgical approach and not to the anesthesia method.

There is no clear preference for GA in TAVI. LA-S appears to be an effective and safe option for eligible patients.