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33

TRANSCATHETER AORTIC VALVE IMPLANTATION UNDER LOCAL ANALGESIA EXCLUSIVELY

3

Table 1.

Procedural characteristics (n=178)

Conversion from local to general anaesthesia

4 (3.3%)

Conversion to surgery

1

Puncture or closure of peripheral vasculature

2

Restlessness of the patient

1

Post-dilatation

17 (9.4%)

Contrast (mL)

147 ± 51

Procedure time (min)

97 ± 38

Device success

174 (96.7%)

Average admission (days)

10 ± 8

Data expressed as number (percentage) or mean ± SD.

Table 2.

Premedication 1 hour before procedure (n=170)

Temazepam 10 mg

33 (19%)

Lorazepam 1 mg

40 (24%)

Midazolam

63 (37%)

7.5 mg

5 (3%)

3.75 mg

58 (34%)

2.5 mg

1 (1%)

Paracetamol 1000 mg

144 (85%)

Data expressed as number (percentage).

Efforts to minimise invasiveness with concurrent maintenance of patient safety and fast-

track recovery, but without compromising clinical and procedural outcomes or patient

satisfaction were the rationale for this simpli ed TAVI approach using exclusively LA. To

our knowledge, we report the largest TAVI cohort performed with LA

1–6

with the lowest

conversion rate to GA. Complication rate (major bleeding, stroke/TIA) was similar to other

registries and trials performed with GA. One of the main reasons for the performance of GA

for TAVI is the assumption that TOE is necessary procedurally. We could demonstrate that

TAVI can be performed safely without TOE

7

, and no complications occurred necessitating

emergency TOE. Post-implantation result of the prosthesis was assessed by fluoroscopy

and TTE. Patients with LA were suf ciently comfortable, even if surgical femoral access was

necessary. Monitoring with direct feedback of an awake patient is superior to monitoring

under sedation or GA. There was no difference in outcome between patients receiving

conscious sedation combined with LA or LA only.

In the presence of an experienced cardio-anaesthetist, no delay is expected in initiating

cardiac support and managing complications.