Regional Anesthesia Approaches for Transcatheter Aortic Valve Implantation: When and Where Does It Add Value? A...

Transcatheter aortic valve implantation (TAVI) is increasingly performed using local infiltration (LI) with monitored anesthesia care (MAC) as outcomes are equivalent to those of general anesthesia. The key clinical question is when regional anesthesia (RA) offers meaningful benefits beyond LI-MAC across different access routes. The objectives were to identify access-specific situations in which RA may provide clinical advantages over LI-MAC and to summarize implications for patient comfort, hemodynamics, and procedural safety. A narrative review of studies retrieved from PubMed (MEDLINE), Embase, and the Cochrane Library through September 2025 was performed. Eligible studies included case reports, randomized trials, observational cohort studies, and reviews describing RA techniques used for TAVI. Data were extracted on access route, RA technique, outcomes, and complications. For transfemoral (TF) TAVI, evidence supports LI-MAC as the default strategy, and RA has not been shown to improve major clinical outcomes. Selective RA adjuncts may enhance intraprocedural comfort: Ilioinguinal-iliohypogastric block reduces sedative and analgesic requirements, and fascia iliaca block may reduce opioid requirements in selected settings. For non-TF access, particularly subclavian or axillary and carotid routes, RA may preserve spontaneous ventilation, stabilize hemodynamics, and enable continuous neurologic monitoring. In transapical and transaortic procedures, thoracic epidural analgesia shows strong observational support for improved pulmonary and clinical outcomes, with paravertebral and plane blocks serving as neuraxial-sparing alternatives. RA should be used selectively when it enhances analgesia, reduces sedative requirements, or confers physiological advantages, particularly for non-TF access. Further studies directly comparing RA with LI-MAC are needed to clarify its access-specific role.