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Local versus general anesthesia for transfemoral aortic valve implantation

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Abstract

Background

Transcatheter aortic valve implantation (TAVI) represents a novel option for elderly with severe aortic valve stenosis who are denied surgical aortic valve replacement due to high perioperative risk. While transfemoral TAVI generally is being performed in general anesthesia (GA), TAVI under local anesthesia plus mild sedation (LAPS) might be an effective and safe alternative.

Methods

In a single-centre analysis, we assessed clinical data, preoperative risk scores (STS-Score), echocardiography, periprocedural data and labor costs in 74 patients undergoing transfemoral TAVI under GA (n = 33) and LAPS (n = 41).

Results

Patients who underwent TAVI in LAPS presented significantly more often with pulmonary hypertension and impaired renal function, and tended to have a higher STS score and more severe symptoms (higher NYHA class) versus the GA group. There were no significant differences in procedure-related 30-day mortality or complications between groups. The peak systolic and mean central aortic pressure were significantly higher in the LAPS group, while at the same time these patients required significantly less often periprocedural adrenergic support. Intervention time was shorter in the LAPS group due to avoidance of surgical cut-down of the access site. Moreover, total procedure time was significantly shorter and labor costs were lower in the LAPS group. Patients who underwent TAVI in LAPS could be mobilized significantly earlier.

Conclusion

Our study indicates that TAVI under LAPS is as effective and safe as TAVI under GA. Furthermore, total procedure time, intervention time and labor costs could be reduced by LAPS. Mobilization of patients could be achieved earlier. We therefore consider LAPS to be favorable in patients undergoing transfemoral TAVI.

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Conflict of interest

The authors have reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed.

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Authors and Affiliations

  1. Department of Internal Medicine II, Paracelsus Medical University Salzburg, Muellner Hauptstr. 48, 5020, Salzburg, Austria

    Lukas J. Motloch, Dennis Rottlaender, Sara Reda, Robert Larbig & Uta C. Hoppe

  2. Department of Internal Medicine III, University of Cologne, Cologne, Germany

    Lukas J. Motloch, Dennis Rottlaender, Sara Reda, Robert Larbig, Marie Bruns, Jochen Müller-Ehmsen, Erland Erdmann & Uta C. Hoppe

  3. Department of Cardiothoracic Surgery, University of Bochum, Bochum, Germany

    Justus Strauch

  4. Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany

    Navid Madershahian & Thorsten Wahlers

  5. Center of Molecular Medicine Cologne, University of Cologne, Cologne, Germany

    Uta C. Hoppe

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  1. Lukas J. Motloch
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  2. Dennis Rottlaender
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  11. Uta C. Hoppe
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Correspondence to Uta C. Hoppe.

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Motloch, L.J., Rottlaender, D., Reda, S. et al. Local versus general anesthesia for transfemoral aortic valve implantation. Clin Res Cardiol 101, 45–53 (2012). https://doi.org/10.1007/s00392-011-0362-8

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  • DOI: https://doi.org/10.1007/s00392-011-0362-8

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