title: Local versus general anesthesia for transfemoral aortic valve implantation.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Internal Medicine II, Paracelsus Medical University Salzburg, Muellner Hauptstr. 48, 5020 Salzburg, Austria.
authors.forename: Lukas J
authors.initials: LJ
authors.lastname: Motloch
authors.forename: Dennis
authors.initials: D
authors.lastname: Rottlaender
authors.forename: Sara
authors.initials: S
authors.lastname: Reda
authors.forename: Robert
authors.initials: R
authors.lastname: Larbig
authors.forename: Marie
authors.initials: M
authors.lastname: Bruns
authors.forename: Jochen
authors.initials: J
authors.lastname: Müller-Ehmsen
authors.forename: Justus
authors.initials: J
authors.lastname: Strauch
authors.forename: Navid
authors.initials: N
authors.lastname: Madershahian
authors.forename: Erland
authors.initials: E
authors.lastname: Erdmann
authors.forename: Thorsten
authors.initials: T
authors.lastname: Wahlers
authors.forename: Uta C
authors.initials: UC
authors.lastname: Hoppe
mesh_terms: D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods*; D000772:Anesthesia, Local / Q000009:adverse effects / Q000379:methods*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods; D005260:Female; D005263:Femoral Artery; D005500:Follow-Up Studies; D017048:Health Care Costs; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000453:epidemiology; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D051437:Renal Insufficiency / Q000453:epidemiology; D013997:Time Factors