General Anesthesia versus Local Anesthesia plus Sedation in High Risk Patients Underwent Transcatheter Aortic Valve Implantation (TAVI): A Retrospective Cohort Study

Objective: Transcatheter Aortic Valve Implantation (TAVI) poses significant challenges concerning anesthesia management. There is no current consensus on the type of safer anesthesia for high-risk patients undergoing TAVI procedures. The aim of this retrospective cohort study was therefore to describe the pre-and perioperative issues related to anesthesia and to compare the outcomes of high-risk patients treated with general anesthesia (GA) versus local anesthesia plus sedation (LAPS) during TAVI procedures. Method: We conducted a study with 49 patients who underwent TAVI under general anesthesia or local anesthesia plus sedation. Patients were retrospectively allocated to two cohort-study groups: GA (n=23) and LAPS (n=26). Demographic characteristics and procedural data were recorded at important time points. Results: The two groups were similar with respect to demographic characteristics. Total colloid consumption was significantly higher in GA group (p<0.001). Heart rates after valve implantation in GA were significantly lower (p<0.05). Mean arterial pressures were similar. Peripheral oxygen saturations before and after valve implantation in GA were significantly higher. The durations of anesthesia and procedure in LAPS group were significantly shorter (p<0.001). Conclusion: Careful preoperative assessments concerning anesthetic agent preferences, complications related to catheterization and hemodynamic stability, as well as a requirement for immobility and adequate analgesia, are very important for successful outcomes. Particularly for cases where there is no need for transesophageal echocardiography or for a cardiovascular surgeon to dissect and repair the artery, we have concluded that LAPS can be used safely during TAVI procedures.