Anesthesia Type and Outcomes After Transfemoral TAVI: A Time-Sensitive Comparative Analysis

Area of Science:

• Cardiovascular Medicine
• Anesthesiology
• Interventional Cardiology

Background:

• Optimal anesthesia strategy for transfemoral transcatheter aortic valve implantation (TAVI) is not well-established.
• This study investigates the impact of local anesthesia (LA), conscious sedation (CS), and general anesthesia (GA) on TAVI outcomes.

Purpose of the Study:

• To compare early and long-term outcomes of different anesthesia strategies in patients undergoing transfemoral TAVI.
• To determine if anesthesia choice independently influences mortality and major adverse cardiovascular and cerebrovascular events (MACCE).

Main Methods:

• Single-center cohort study of 401 patients undergoing transfemoral TAVI.
• Patients were stratified into LA (n=77), CS (n=147), and GA (n=177) groups.
• Outcomes assessed via win-ratio analysis, Kaplan-Meier, restricted mean survival time (RMST), and inverse probability of treatment weighting (IPTW) for adjustment.

Main Results:

• Unadjusted analyses showed LA superior to GA for early survival (0-6 months, win ratio 1.79).
• Multivariable adjustment confirmed LA superiority over GA at 6-12 and 12-24 months.
• IPTW-adjusted analyses revealed no independent association between anesthesia type and mortality or MACCE, suggesting baseline risk differences influenced initial findings.

Conclusions:

• Minimally invasive anesthesia (LA, CS) showed favorable early survival patterns in unadjusted TAVI analyses.
• After accounting for baseline patient risk profiles via IPTW, anesthesia strategy was not an independent predictor of mortality or MACCE.
• Apparent outcome differences likely reflect underlying patient characteristics rather than a direct causal effect of the anesthesia method.