title: Transcatheter aortic valve implantation, patient selection process and procedure: two centres' experience of the intervention without general anaesthesia.
abstract: BACKGROUND
  transcatheter aortic valve implantation (TAVI) is an emerging technique for the treatment of aortic stenosis. With the advent of percutaneous suture devices for the access point and prosthesis delivery systems of smaller diameter, TAVI has become a truly percutaneous procedure: percutaneous aortic valve replacement (PAVR). Thus, PAVR may be conducted without general anaesthesia (GA).
  
  
  METHODS
  We report two centres' experience from PAVR without GA. CoreValve aortic bioprostheses were utilised. The patient selection process and PAVR procedure are described in detail.
  
  
  RESULTS
  a total of 30 patients (pts) were treated with PAVR. In 4 pts correction of the initial malposition of the prosthesis required a special technique (2 pts: "snare"; 2 pts: "removing and reinserting"). At 1-month follow up, haemodynamic and clinical improvements were observed: left ventricular ejection fraction increased from 50.8 ± 9.3% to 54.3 ± 8.3% (p=0.02); peak aortic valve gradient decreased from 90.3 ± 26.4 mmHg to 14.8 ± 9.7 mmHg, (p<0.001); NYHA functional class decreased from 3.53 ± 0.93 to 1.45 ± 0.94 (p<0.001). Overall 1-month mortality was 3.3% (1 patient died).
  
  
  CONCLUSIONS
  PAVR without general anaesthesia is a feasible technique, however the role of anaesthesiologists is still important.
authors.affiliation: First Department of Cardiology, Hippokration Hospital, National & Kapodistrian University of Athens, Greece. vavouran@otenet.gr
authors.forename: Manolis
authors.initials: M
authors.lastname: Vavuranakis
authors.forename: Vasileios
authors.initials: V
authors.lastname: Voudris
authors.forename: Dimitrios A
authors.initials: DA
authors.lastname: Vrachatis
authors.forename: Sofia
authors.initials: S
authors.lastname: Thomopoulou
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Toutouzas
authors.forename: George
authors.initials: G
authors.lastname: Karavolias
authors.forename: Ioannis
authors.initials: I
authors.lastname: Tolios
authors.forename: Eftihia
authors.initials: E
authors.lastname: Sbarouni
authors.forename: George
authors.initials: G
authors.lastname: Lazaros
authors.forename: Christina
authors.initials: C
authors.lastname: Chrysohoou
authors.forename: Mazen
authors.initials: M
authors.lastname: Khoury
authors.forename: Stella
authors.initials: S
authors.lastname: Brili
authors.forename: Marina
authors.initials: M
authors.lastname: Balanika
authors.forename: Carmen
authors.initials: C
authors.lastname: Moldovan
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Stefanadis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001705:Bioprosthesis; D017023:Coronary Angiography; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012850:Sinus of Valsalva