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Chapter 3
ABSTRACT
Background:
Both, general anaesthesia (GA) and local analgesia (LA) - with or without
sedation - are options for periprocedural anaesthetic management of transfemoral
transcatheter aortic valve implantation (TAVI). We report the safety and feasibility of TAVI
under LA and provide our own experience in the largest cohort so far reported.
Methods:
A total of 178 consecutive patients planned for transfemoral TAVI were included
in this study. Patients were treated with the Medtronic Core Valve (n=77) or the Edwards
Sapien (n=101) at operators’ discretion. Periprocedural anaesthetic management,
procedural characteristics, and outcomes were assessed.
Results:
Of the 178 patients (34%male), 4 (2.2%) needed a conversion to general anaesthesia
(prosthesis embolism, 2 complicatedperipheral vasculaturepuncture/closures, restlessness).
Periprocedural transoesophageal echocardiography was not necessary. Premedication
included temazepam, lorazepam, or midazolam in 76% of patients. In total 115 patients
(66%) received conscious sedation, 34% received sedative medications. Only nine patients
developed a delirium during admission (5%). All-cause 30day-mortality was 9 (5%). NYHA-
class decreased significantly from 3±0.6 to 1±0.9 (p=0.04).
Conclusion:
Transfemoral TAVI - using exclusively local analgesia and fluoroscopic guidance
- is safe and feasible with a very low rate of conversion. The fragile TAVI-population may
benefit from this anaesthetic management.