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Local Versus General Anesthesia in Transcatheter Aortic Valve Replacement

      Transcatheter aortic valve replacement (TAVR) is conventionally performed under general anesthesia (GA) allowing intraoperative transoesophageal echocardiogram imaging. We present our experience in patients having the procedure under local anesthesia (LA), who were subsequently transferred to a low dependency unit postprocedure, to assess safety and length of hospital stay. We retrospectively assessed all the transfemoral TAVR procedures conducted at our center from January 03, 2011. Of 216 patients, 145 had the procedure under GA and 71 under LA. Both groups were similar with respect to age, co-morbidities, Euro Score, and the severity of the aortic stenosis. The procedure time was significantly shorter in the LA group measured from time in room to skin closure (108 vs 143 minutes, p <0.001). Skin open to skin closure time were the same in both groups (78 vs 79.4 minutes, p = 0.57). There was no difference in 30 days: aortic regurgitation > mild (2.1% in GA and 2.8% in LA, p = 0.67), need for permanent pacing (3.4% in GA and 1.4% in LA, p = 0.32), and disabling cerebrovascular accidents (1.4% and 1.4%, p = 1.0). The 30-day survival was not significantly different (95.9% in GA and 100% in LA, p = 0.17), whereas the median number of days in hospital was shorter in the LA group (4 in GA and 2 in LA, p <0.001). No emergency conversions to GA were performed in the LA group and only 1 patient needed admission to a high dependency (HD) unit. In conclusion, performing a TAVR under LA is at least as safe as GA. In addition, there is a reduced procedural time and length of hospital stay. LA is a safe and cost-effective alternative to GA and patients can be safely transferred to a low dependency unit.
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      References

        • Leon M.B.
        • Smith C.R.
        • Mack M.
        • Miller D.C.
        • Moses J.W.
        • Svensson L.G.
        • Tuzcu E.M.
        • Webb J.G.
        • Fontana G.P.
        • Makkar R.R.
        • Brown D.L.
        • Block P.C.
        • Guyton R.A.
        • Pichard A.D.
        • Bavaria J.E.
        • Herrmann H.C.
        • Douglas P.S.
        • Petersen J.L.
        • Akin J.J.
        • Anderson W.N.
        • Wang D.
        • Pocock S.
        • PARTNER Trial Investigators
        Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery.
        N Engl J Med. 2010; 363: 1597-1607
        • Cribier A.
        • Eltchaninoff H.
        • Tron C.
        • Bauer F.
        • Agatiello C.
        • Nercolini D.
        • Tapiero S.
        • Litzler P.Y.
        • Bessou J.P.
        • Babaliaros V.
        Treatment of calcific aortic stenosis with the percutaneous heart valve: mid-term follow-up from the initial feasibility studies: the French experience.
        J Am Coll Cardiol. 2006; 47: 1214-1223
        • Webb J.G.
        • Pasupati S.
        • Humphries K.
        • Thompson C.
        • Altwegg L.
        • Moss R.
        • Sinhal A.
        • Carere R.G.
        • Munt B.
        • Ricci D.
        • Ye J.
        • Cheung A.
        • Lichtenstein S.V.
        Percutaneous transarterial aortic valve replacement in selected high-risk patients with aortic stenosis.
        Circulation. 2007; 116: 755-763
        • Grube E.
        • Schuler G.
        • Buellesfeld L.
        • Gerckens U.
        • Linke A.
        • Wenaweser P.
        • Sauren B.
        • Mohr F.W.
        • Walther T.
        • Zickmann B.
        • Iversen S.
        • Felderhoff T.
        • Cartier R.
        • Bonan R.
        Percutaneous aortic valve replacement for severe aortic stenosis in high-risk patients using the second- and current third-generation self-expanding CoreValve prosthesis: device success and 30-day clinical outcome.
        J Am Coll Cardiol. 2007; 50: 69-76
        • Leon M.B.
        • Piazza N.
        • Nikolsky E.
        • Blackstone E.H.
        • Cutlip D.E.
        • Kappetein A.P.
        • Krucoff M.W.
        • Mack M.
        • Mehran R.
        • Miller C.
        • Morel M.A.
        • Petersen J.
        • Popma J.J.
        • Takkenberg J.J.
        • Vahanian A.
        • van Es G.A.
        • Vranckx P.
        • Webb J.G.
        • Windecker S.
        • Serruys P.W.
        Standardized endpoint definitions for transcatheter aortic valve implantation clinical trials: a consensus report from the Valve Academic Research Consortium.
        Eur Heart J. 2011; 32: 205-217
        • Greif M.
        • Lange P.
        • Nabauer M.
        • Schwarz F.
        • Becker C.
        • Schmitz C.
        • Pohl T.
        • D'Anastasi M.
        • Boekstegers P.
        • Massberg S.
        • Kupatt C.
        Transcutaneous aortic valve replacement with the Edwards SAPIEN XT and Medtronic CoreValve prosthesis under fluoroscopic guidance and local anaesthesia only.
        Heart. 2014; 100: 691-695
        • Durand E.
        • Eltchaninoff H.
        • Canville A.
        • Bouhzam N.
        • Godin M.
        • Tron C.
        • Rodriguez C.
        • Litzler P.Y.
        • Bauer F.
        • Cribier A.
        Feasibility and safety of early discharge after transfemoral transcatheter aortic valve implantation with the Edwards SAPIEN-XT prosthesis.
        Am J Cardiol. 2015; 115: 1116-1122
        • Babaliaros V.
        • Devireddy C.
        • Lerakis S.
        • Leonardi R.
        • Iturra S.A.
        • Mavromatis K.
        • Leshnower B.G.
        • Guyton R.A.
        • Kanitkar M.
        • Keegan P.
        • Simone A.
        • Stewart J.P.
        • Ghasemzadeh N.
        • Block P.
        • Thourani V.H.
        Comparison of transfemoral transcatheter aortic valve replacement performed in the catheterization laboratory (minimalist approach) versus hybrid operating room (standard approach): outcomes and cost analysis.
        JACC Cardiovasc Interv. 2014; 7: 898-904
        • Webb J.
        • Gerosa G.
        • Lefevre T.
        • Leipsic J.
        • Spence M.
        • Thomas M.
        • Thielmann M.
        • Treede H.
        • Wendler O.
        • Walther T.
        Multicenter evaluation of a next-generation balloon-expandable transcatheter aortic valve.
        J Am Coll Cardiol. 2014; 64: 2235-2243
        • Oguri A.
        • Yamamoto M.
        • Mouillet G.
        • Gilard M.
        • Laskar M.
        • Eltchaninoff H.
        • Fajadet J.
        • Iung B.
        • Donzeau-Gouge P.
        • Leprince P.
        • Leguerrier A.
        • Prat A.
        • Lievre M.
        • Chevreul K.
        • Dubois-Rande J.L.
        • Chopard R.
        • Van Belle E.
        • Otsuka T.
        • Teiger E.
        • FRANCE 2 Registry Investigators
        Clinical outcomes and safety of transfemoral aortic valve implantation under general versus local anesthesia: subanalysis of the French Aortic National CoreValve and Edwards 2 registry.
        Circ Cardiovasc Interv. 2014; 7: 602-610