Local versus general anesthesia for transfemoral aortic valve implantation

Lukas J. Motloch, Dennis Rottlaender, Sara Reda, Robert Larbig, Marie Bruns, Jochen Müller-Ehmsen, Justus Strauch, Navid Madershahian, Erland Erdmann, Thorsten Wahlers, Uta C. Hoppe

Research output: Contribution to journalArticlepeer-review

147 Scopus citations

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.

Original languageEnglish
Pages (from-to)45-53
Number of pages9
JournalClinical Research in Cardiology
Volume101
Issue number1
DOIs
StatePublished - Jan 2012
Externally publishedYes

Keywords

  • Aortic stenosis
  • General anesthesia
  • Local anesthesia
  • Procedure time
  • Transcatheter aortic valve implantation
  • Transfemoral

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