Minimalist transcatheter aortic valve implantation for all? Consensus clinical guidance from Italy

The evolution of transcatheter aortic valve implantation (TAVI) technology has enabled a shift towards less invasive, patient-centred perioperative and anaesthetic care. Current evidence from randomised trials indicates that conscious sedation and minimalist approaches are safe in appropriately selected patients, but conversion rates and patient experience highlight the need for careful case selection. The Italian expert consensus in a recent issue of the British Journal of Anaesthesia provides timely and clinically relevant guidance, supporting a default minimally invasive strategy (local anaesthesia or conscious sedation) delivered by anaesthetists, with escalation of monitoring and anaesthetic intensity only in higher-risk clinical scenarios. In the absence of robust comparative evidence for many aspects of care, Ajello and colleagues introduce a pragmatic clinical approach, individualised towards patients' needs, which helps to standardise practice, optimise patient comfort and outcomes, and reduce unnecessary invasiveness of monitoring. Future pragmatic clinical research is needed to better integrate patient-centred outcomes into anaesthetic practice.