Management of anaesthesia for transfemoral transcatheter aortic valve implantation: an Italian interdisciplinary...

Transfemoral transcatheter aortic valve implantation (TAVI) is a minimally invasive treatment for patients with severe aortic stenosis who are at elevated surgical risk. Despite widespread use, optimal periprocedural anaesthetic management remains highly variable, and evidence-based guidance is lacking.

An interdisciplinary panel of Italian experts in anaesthesiology, cardiology, and cardiac surgery conducted a systematic review of the literature and used the RAND/UCLA Appropriateness Method to evaluate 1032 clinical scenarios across a range of risk profiles and comorbid conditions. Ratings were conducted over three rounds, including a moderated in-person meeting to refine and discuss appropriateness scores.

A minimally invasive approach, local anaesthesia alone, and conscious sedation were judged appropriate across most clinical scenarios. Invasive monitoring, such as placement of an additional arterial catheter or a central venous catheter, was recommended only in selected high-risk patients. Several approaches or interventions were consistently rated inappropriate across all evaluated scenarios, including nurse-administered anaesthesia, pulmonary artery catheterisation, and cardiac output monitoring using pulse wave analysis. Other approaches, such as general anaesthesia and deep sedation, were considered inappropriate in most cases but retained uncertainty in select clinical contexts. Several recommendations were rated as necessary to define a minimum standard of care.

This Italian consensus statement provides practical, expert-driven recommendations to standardise anaesthetic care for transfemoral TAVI. While many recommendations reached strong consensus, areas of uncertainty remain, underscoring the need for further clinical research. Patient-centred, individualised decision-making remains essential, guided by institutional experience and procedural complexity.