Local Versus General Anesthesia in Transcatheter Aortic Valve Replacement

Abstract

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.