title: Clinical outcomes and safety of transfemoral aortic valve implantation under general versus local anesthesia: subanalysis of the French Aortic National CoreValve and Edwards 2 registry.
abstract: BACKGROUND
  Transcatheter aortic valve implantation (TAVI) performed under local anesthesia (LA) is becoming increasingly common. We aimed to compare the clinical outcomes in patients who underwent transfemoral-TAVI under general anesthesia (GA) and LA.
  
  
  RESULTS
  Data from 2326 patients in the French Aortic National CoreValve and Edwards 2 (FRANCE 2) registry who underwent transfemoral-TAVI were analyzed. During the study period, the percentage of LA procedures increased gradually from 14% in January 2010 to 59% in October 2011. The clinical outcomes for GA (n=1377) and LA (n=949) were compared. Numerous baseline characteristics differed between the 2 groups, and the use of transesophageal echocardiographic guidance was more common in GA than in LA (76.3% versus 16.9%; P<0.001). Device success and cumulative 30-day survival rates were similar in the 2 groups (97.6% versus 97.0%; P=0.41 and 91.6% versus 91.3%; P=0.69, respectively), whereas the incidence of postprocedural aortic regurgitation≥mild was significantly lower in GA than in LA (15.0% versus 19.1%; P=0.015). The groups were also analyzed using a propensity-matching model, including transesophageal echocardiographic usage (GA [n=401] versus LA [n=401]). This model indicated that there were no significant differences between the 2 groups in the rates of 30-day survival (GA [91.4%] versus LA [89.3%]; P=0.27] and postprocedural aortic regurgitation≥mild (GA [12.7%] versus LA [16.2%]; P=0.19).
  
  
  CONCLUSIONS
  The less invasive transfemoral-TAVI under LA is preferred in clinical settings and seems to be acceptable; however, the higher incidence of postprocedural aortic regurgitation is emphasized. Therapeutic efforts should be made to reduce such complications during transfemoral-TAVI under LA.
authors.affiliation: From the Centre Hospitalier Universitaire (CHU) Henri Mondor, Creteil, France (A.O., M.Y., G.M., K.C., J.-L.D.-R., E.T.); Centre Hospitalier Universitaire Brest, Brest, France (M.G.); Centre Hospitalier Universitaire Dupuytren, Limoges, France (M. Laskar); Hopital Charles Nicolle, University of Rouen, INSERM Unite 1096, Rouen, France (H.E.); Clinique Pasteur, Toulouse, France (J.F.); Bichat Hospital, Paris, France (B.I.); Insitut Jacques Cartier, Massy, France (P.D.-G.); Pitie-Salpetriere Hospital, Paris, France (P.L.); Centre Hospitalier Universitaire Rennes, Rennes, France (A.L.); Centre Hospitalier Universitaire Lille, Lille, France (A.P., E.V.B.); University Lyon 1, Lyon, France (M. Lievre); Centre Hospitalier Universitaire Besançon, Besançon, France (R.C.); and Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.).
authors.forename: Atsushi
authors.initials: A
authors.lastname: Oguri
authors.affiliation: From the Centre Hospitalier Universitaire (CHU) Henri Mondor, Creteil, France (A.O., M.Y., G.M., K.C., J.-L.D.-R., E.T.); Centre Hospitalier Universitaire Brest, Brest, France (M.G.); Centre Hospitalier Universitaire Dupuytren, Limoges, France (M. Laskar); Hopital Charles Nicolle, University of Rouen, INSERM Unite 1096, Rouen, France (H.E.); Clinique Pasteur, Toulouse, France (J.F.); Bichat Hospital, Paris, France (B.I.); Insitut Jacques Cartier, Massy, France (P.D.-G.); Pitie-Salpetriere Hospital, Paris, France (P.L.); Centre Hospitalier Universitaire Rennes, Rennes, France (A.L.); Centre Hospitalier Universitaire Lille, Lille, France (A.P., E.V.B.); University Lyon 1, Lyon, France (M. Lievre); Centre Hospitalier Universitaire Besançon, Besançon, France (R.C.); and Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.). masa-nori@nms.ac.jp emmanuel.teiger@hmn.aphp.fr.
authors.forename: Masanori
authors.initials: M
authors.lastname: Yamamoto
authors.affiliation: From the Centre Hospitalier Universitaire (CHU) Henri Mondor, Creteil, France (A.O., M.Y., G.M., K.C., J.-L.D.-R., E.T.); Centre Hospitalier Universitaire Brest, Brest, France (M.G.); Centre Hospitalier Universitaire Dupuytren, Limoges, France (M. Laskar); Hopital Charles Nicolle, University of Rouen, INSERM Unite 1096, Rouen, France (H.E.); Clinique Pasteur, Toulouse, France (J.F.); Bichat Hospital, Paris, France (B.I.); Insitut Jacques Cartier, Massy, France (P.D.-G.); Pitie-Salpetriere Hospital, Paris, France (P.L.); Centre Hospitalier Universitaire Rennes, Rennes, France (A.L.); Centre Hospitalier Universitaire Lille, Lille, France (A.P., E.V.B.); University Lyon 1, Lyon, France (M. Lievre); Centre Hospitalier Universitaire Besançon, Besançon, France (R.C.); and Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.).
authors.forename: Gauthier
authors.initials: G
authors.lastname: Mouillet
authors.affiliation: From the Centre Hospitalier Universitaire (CHU) Henri Mondor, Creteil, France (A.O., M.Y., G.M., K.C., J.-L.D.-R., E.T.); Centre Hospitalier Universitaire Brest, Brest, France (M.G.); Centre Hospitalier Universitaire Dupuytren, Limoges, France (M. Laskar); Hopital Charles Nicolle, University of Rouen, INSERM Unite 1096, Rouen, France (H.E.); Clinique Pasteur, Toulouse, France (J.F.); Bichat Hospital, Paris, France (B.I.); Insitut Jacques Cartier, Massy, France (P.D.-G.); Pitie-Salpetriere Hospital, Paris, France (P.L.); Centre Hospitalier Universitaire Rennes, Rennes, France (A.L.); Centre Hospitalier Universitaire Lille, Lille, France (A.P., E.V.B.); University Lyon 1, Lyon, France (M. Lievre); Centre Hospitalier Universitaire Besançon, Besançon, France (R.C.); and Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.).
authors.forename: Martine
authors.initials: M
authors.lastname: Gilard
authors.affiliation: From the Centre Hospitalier Universitaire (CHU) Henri Mondor, Creteil, France (A.O., M.Y., G.M., K.C., J.-L.D.-R., E.T.); Centre Hospitalier Universitaire Brest, Brest, France (M.G.); Centre Hospitalier Universitaire Dupuytren, Limoges, France (M. Laskar); Hopital Charles Nicolle, University of Rouen, INSERM Unite 1096, Rouen, France (H.E.); Clinique Pasteur, Toulouse, France (J.F.); Bichat Hospital, Paris, France (B.I.); Insitut Jacques Cartier, Massy, France (P.D.-G.); Pitie-Salpetriere Hospital, Paris, France (P.L.); Centre Hospitalier Universitaire Rennes, Rennes, France (A.L.); Centre Hospitalier Universitaire Lille, Lille, France (A.P., E.V.B.); University Lyon 1, Lyon, France (M. Lievre); Centre Hospitalier Universitaire Besançon, Besançon, France (R.C.); and Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.).
authors.forename: Marc
authors.initials: M
authors.lastname: Laskar
authors.affiliation: From the Centre Hospitalier Universitaire (CHU) Henri Mondor, Creteil, France (A.O., M.Y., G.M., K.C., J.-L.D.-R., E.T.); Centre Hospitalier Universitaire Brest, Brest, France (M.G.); Centre Hospitalier Universitaire Dupuytren, Limoges, France (M. Laskar); Hopital Charles Nicolle, University of Rouen, INSERM Unite 1096, Rouen, France (H.E.); Clinique Pasteur, Toulouse, France (J.F.); Bichat Hospital, Paris, France (B.I.); Insitut Jacques Cartier, Massy, France (P.D.-G.); Pitie-Salpetriere Hospital, Paris, France (P.L.); Centre Hospitalier Universitaire Rennes, Rennes, France (A.L.); Centre Hospitalier Universitaire Lille, Lille, France (A.P., E.V.B.); University Lyon 1, Lyon, France (M. Lievre); Centre Hospitalier Universitaire Besançon, Besançon, France (R.C.); and Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.).
authors.forename: Helene
authors.initials: H
authors.lastname: Eltchaninoff
authors.affiliation: From the Centre Hospitalier Universitaire (CHU) Henri Mondor, Creteil, France (A.O., M.Y., G.M., K.C., J.-L.D.-R., E.T.); Centre Hospitalier Universitaire Brest, Brest, France (M.G.); Centre Hospitalier Universitaire Dupuytren, Limoges, France (M. Laskar); Hopital Charles Nicolle, University of Rouen, INSERM Unite 1096, Rouen, France (H.E.); Clinique Pasteur, Toulouse, France (J.F.); Bichat Hospital, Paris, France (B.I.); Insitut Jacques Cartier, Massy, France (P.D.-G.); Pitie-Salpetriere Hospital, Paris, France (P.L.); Centre Hospitalier Universitaire Rennes, Rennes, France (A.L.); Centre Hospitalier Universitaire Lille, Lille, France (A.P., E.V.B.); University Lyon 1, Lyon, France (M. Lievre); Centre Hospitalier Universitaire Besançon, Besançon, France (R.C.); and Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.).
authors.forename: Jean
authors.initials: J
authors.lastname: Fajadet
authors.affiliation: From the Centre Hospitalier Universitaire (CHU) Henri Mondor, Creteil, France (A.O., M.Y., G.M., K.C., J.-L.D.-R., E.T.); Centre Hospitalier Universitaire Brest, Brest, France (M.G.); Centre Hospitalier Universitaire Dupuytren, Limoges, France (M. Laskar); Hopital Charles Nicolle, University of Rouen, INSERM Unite 1096, Rouen, France (H.E.); Clinique Pasteur, Toulouse, France (J.F.); Bichat Hospital, Paris, France (B.I.); Insitut Jacques Cartier, Massy, France (P.D.-G.); Pitie-Salpetriere Hospital, Paris, France (P.L.); Centre Hospitalier Universitaire Rennes, Rennes, France (A.L.); Centre Hospitalier Universitaire Lille, Lille, France (A.P., E.V.B.); University Lyon 1, Lyon, France (M. Lievre); Centre Hospitalier Universitaire Besançon, Besançon, France (R.C.); and Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.).
authors.forename: Bernard
authors.initials: B
authors.lastname: Iung
authors.affiliation: From the Centre Hospitalier Universitaire (CHU) Henri Mondor, Creteil, France (A.O., M.Y., G.M., K.C., J.-L.D.-R., E.T.); Centre Hospitalier Universitaire Brest, Brest, France (M.G.); Centre Hospitalier Universitaire Dupuytren, Limoges, France (M. Laskar); Hopital Charles Nicolle, University of Rouen, INSERM Unite 1096, Rouen, France (H.E.); Clinique Pasteur, Toulouse, France (J.F.); Bichat Hospital, Paris, France (B.I.); Insitut Jacques Cartier, Massy, France (P.D.-G.); Pitie-Salpetriere Hospital, Paris, France (P.L.); Centre Hospitalier Universitaire Rennes, Rennes, France (A.L.); Centre Hospitalier Universitaire Lille, Lille, France (A.P., E.V.B.); University Lyon 1, Lyon, France (M. Lievre); Centre Hospitalier Universitaire Besançon, Besançon, France (R.C.); and Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.).
authors.forename: Patrick
authors.initials: P
authors.lastname: Donzeau-Gouge
authors.affiliation: From the Centre Hospitalier Universitaire (CHU) Henri Mondor, Creteil, France (A.O., M.Y., G.M., K.C., J.-L.D.-R., E.T.); Centre Hospitalier Universitaire Brest, Brest, France (M.G.); Centre Hospitalier Universitaire Dupuytren, Limoges, France (M. Laskar); Hopital Charles Nicolle, University of Rouen, INSERM Unite 1096, Rouen, France (H.E.); Clinique Pasteur, Toulouse, France (J.F.); Bichat Hospital, Paris, France (B.I.); Insitut Jacques Cartier, Massy, France (P.D.-G.); Pitie-Salpetriere Hospital, Paris, France (P.L.); Centre Hospitalier Universitaire Rennes, Rennes, France (A.L.); Centre Hospitalier Universitaire Lille, Lille, France (A.P., E.V.B.); University Lyon 1, Lyon, France (M. Lievre); Centre Hospitalier Universitaire Besançon, Besançon, France (R.C.); and Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.).
authors.forename: Pascal
authors.initials: P
authors.lastname: Leprince
authors.affiliation: From the Centre Hospitalier Universitaire (CHU) Henri Mondor, Creteil, France (A.O., M.Y., G.M., K.C., J.-L.D.-R., E.T.); Centre Hospitalier Universitaire Brest, Brest, France (M.G.); Centre Hospitalier Universitaire Dupuytren, Limoges, France (M. Laskar); Hopital Charles Nicolle, University of Rouen, INSERM Unite 1096, Rouen, France (H.E.); Clinique Pasteur, Toulouse, France (J.F.); Bichat Hospital, Paris, France (B.I.); Insitut Jacques Cartier, Massy, France (P.D.-G.); Pitie-Salpetriere Hospital, Paris, France (P.L.); Centre Hospitalier Universitaire Rennes, Rennes, France (A.L.); Centre Hospitalier Universitaire Lille, Lille, France (A.P., E.V.B.); University Lyon 1, Lyon, France (M. Lievre); Centre Hospitalier Universitaire Besançon, Besançon, France (R.C.); and Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.).
authors.forename: Alain
authors.initials: A
authors.lastname: Leguerrier
authors.affiliation: From the Centre Hospitalier Universitaire (CHU) Henri Mondor, Creteil, France (A.O., M.Y., G.M., K.C., J.-L.D.-R., E.T.); Centre Hospitalier Universitaire Brest, Brest, France (M.G.); Centre Hospitalier Universitaire Dupuytren, Limoges, France (M. Laskar); Hopital Charles Nicolle, University of Rouen, INSERM Unite 1096, Rouen, France (H.E.); Clinique Pasteur, Toulouse, France (J.F.); Bichat Hospital, Paris, France (B.I.); Insitut Jacques Cartier, Massy, France (P.D.-G.); Pitie-Salpetriere Hospital, Paris, France (P.L.); Centre Hospitalier Universitaire Rennes, Rennes, France (A.L.); Centre Hospitalier Universitaire Lille, Lille, France (A.P., E.V.B.); University Lyon 1, Lyon, France (M. Lievre); Centre Hospitalier Universitaire Besançon, Besançon, France (R.C.); and Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.).
authors.forename: Alain
authors.initials: A
authors.lastname: Prat
authors.affiliation: From the Centre Hospitalier Universitaire (CHU) Henri Mondor, Creteil, France (A.O., M.Y., G.M., K.C., J.-L.D.-R., E.T.); Centre Hospitalier Universitaire Brest, Brest, France (M.G.); Centre Hospitalier Universitaire Dupuytren, Limoges, France (M. Laskar); Hopital Charles Nicolle, University of Rouen, INSERM Unite 1096, Rouen, France (H.E.); Clinique Pasteur, Toulouse, France (J.F.); Bichat Hospital, Paris, France (B.I.); Insitut Jacques Cartier, Massy, France (P.D.-G.); Pitie-Salpetriere Hospital, Paris, France (P.L.); Centre Hospitalier Universitaire Rennes, Rennes, France (A.L.); Centre Hospitalier Universitaire Lille, Lille, France (A.P., E.V.B.); University Lyon 1, Lyon, France (M. Lievre); Centre Hospitalier Universitaire Besançon, Besançon, France (R.C.); and Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.).
authors.forename: Michel
authors.initials: M
authors.lastname: Lievre
authors.affiliation: From the Centre Hospitalier Universitaire (CHU) Henri Mondor, Creteil, France (A.O., M.Y., G.M., K.C., J.-L.D.-R., E.T.); Centre Hospitalier Universitaire Brest, Brest, France (M.G.); Centre Hospitalier Universitaire Dupuytren, Limoges, France (M. Laskar); Hopital Charles Nicolle, University of Rouen, INSERM Unite 1096, Rouen, France (H.E.); Clinique Pasteur, Toulouse, France (J.F.); Bichat Hospital, Paris, France (B.I.); Insitut Jacques Cartier, Massy, France (P.D.-G.); Pitie-Salpetriere Hospital, Paris, France (P.L.); Centre Hospitalier Universitaire Rennes, Rennes, France (A.L.); Centre Hospitalier Universitaire Lille, Lille, France (A.P., E.V.B.); University Lyon 1, Lyon, France (M. Lievre); Centre Hospitalier Universitaire Besançon, Besançon, France (R.C.); and Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.).
authors.forename: Karine
authors.initials: K
authors.lastname: Chevreul
authors.affiliation: From the Centre Hospitalier Universitaire (CHU) Henri Mondor, Creteil, France (A.O., M.Y., G.M., K.C., J.-L.D.-R., E.T.); Centre Hospitalier Universitaire Brest, Brest, France (M.G.); Centre Hospitalier Universitaire Dupuytren, Limoges, France (M. Laskar); Hopital Charles Nicolle, University of Rouen, INSERM Unite 1096, Rouen, France (H.E.); Clinique Pasteur, Toulouse, France (J.F.); Bichat Hospital, Paris, France (B.I.); Insitut Jacques Cartier, Massy, France (P.D.-G.); Pitie-Salpetriere Hospital, Paris, France (P.L.); Centre Hospitalier Universitaire Rennes, Rennes, France (A.L.); Centre Hospitalier Universitaire Lille, Lille, France (A.P., E.V.B.); University Lyon 1, Lyon, France (M. Lievre); Centre Hospitalier Universitaire Besançon, Besançon, France (R.C.); and Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.).
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Dubois-Rande
authors.affiliation: From the Centre Hospitalier Universitaire (CHU) Henri Mondor, Creteil, France (A.O., M.Y., G.M., K.C., J.-L.D.-R., E.T.); Centre Hospitalier Universitaire Brest, Brest, France (M.G.); Centre Hospitalier Universitaire Dupuytren, Limoges, France (M. Laskar); Hopital Charles Nicolle, University of Rouen, INSERM Unite 1096, Rouen, France (H.E.); Clinique Pasteur, Toulouse, France (J.F.); Bichat Hospital, Paris, France (B.I.); Insitut Jacques Cartier, Massy, France (P.D.-G.); Pitie-Salpetriere Hospital, Paris, France (P.L.); Centre Hospitalier Universitaire Rennes, Rennes, France (A.L.); Centre Hospitalier Universitaire Lille, Lille, France (A.P., E.V.B.); University Lyon 1, Lyon, France (M. Lievre); Centre Hospitalier Universitaire Besançon, Besançon, France (R.C.); and Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.).
authors.forename: Romain
authors.initials: R
authors.lastname: Chopard
authors.affiliation: From the Centre Hospitalier Universitaire (CHU) Henri Mondor, Creteil, France (A.O., M.Y., G.M., K.C., J.-L.D.-R., E.T.); Centre Hospitalier Universitaire Brest, Brest, France (M.G.); Centre Hospitalier Universitaire Dupuytren, Limoges, France (M. Laskar); Hopital Charles Nicolle, University of Rouen, INSERM Unite 1096, Rouen, France (H.E.); Clinique Pasteur, Toulouse, France (J.F.); Bichat Hospital, Paris, France (B.I.); Insitut Jacques Cartier, Massy, France (P.D.-G.); Pitie-Salpetriere Hospital, Paris, France (P.L.); Centre Hospitalier Universitaire Rennes, Rennes, France (A.L.); Centre Hospitalier Universitaire Lille, Lille, France (A.P., E.V.B.); University Lyon 1, Lyon, France (M. Lievre); Centre Hospitalier Universitaire Besançon, Besançon, France (R.C.); and Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.).
authors.forename: Eric
authors.initials: E
authors.lastname: Van Belle
authors.affiliation: From the Centre Hospitalier Universitaire (CHU) Henri Mondor, Creteil, France (A.O., M.Y., G.M., K.C., J.-L.D.-R., E.T.); Centre Hospitalier Universitaire Brest, Brest, France (M.G.); Centre Hospitalier Universitaire Dupuytren, Limoges, France (M. Laskar); Hopital Charles Nicolle, University of Rouen, INSERM Unite 1096, Rouen, France (H.E.); Clinique Pasteur, Toulouse, France (J.F.); Bichat Hospital, Paris, France (B.I.); Insitut Jacques Cartier, Massy, France (P.D.-G.); Pitie-Salpetriere Hospital, Paris, France (P.L.); Centre Hospitalier Universitaire Rennes, Rennes, France (A.L.); Centre Hospitalier Universitaire Lille, Lille, France (A.P., E.V.B.); University Lyon 1, Lyon, France (M. Lievre); Centre Hospitalier Universitaire Besançon, Besançon, France (R.C.); and Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.).
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Otsuka
authors.affiliation: From the Centre Hospitalier Universitaire (CHU) Henri Mondor, Creteil, France (A.O., M.Y., G.M., K.C., J.-L.D.-R., E.T.); Centre Hospitalier Universitaire Brest, Brest, France (M.G.); Centre Hospitalier Universitaire Dupuytren, Limoges, France (M. Laskar); Hopital Charles Nicolle, University of Rouen, INSERM Unite 1096, Rouen, France (H.E.); Clinique Pasteur, Toulouse, France (J.F.); Bichat Hospital, Paris, France (B.I.); Insitut Jacques Cartier, Massy, France (P.D.-G.); Pitie-Salpetriere Hospital, Paris, France (P.L.); Centre Hospitalier Universitaire Rennes, Rennes, France (A.L.); Centre Hospitalier Universitaire Lille, Lille, France (A.P., E.V.B.); University Lyon 1, Lyon, France (M. Lievre); Centre Hospitalier Universitaire Besançon, Besançon, France (R.C.); and Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.).
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Teiger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D000772:Anesthesia, Local; D001022:Aortic Valve Insufficiency / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D005263:Femoral Artery / Q000187:drug effects* / Q000473:pathology / Q000601:surgery; D005602:France; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery*; D012042:Registries; D016019:Survival Analysis; D065467:Transcatheter Aortic Valve Replacement / Q000401:mortality; D016896:Treatment Outcome
keywords: anesthesia, general; anesthesia, local