title: Local and general anaesthesia do not influence outcome of transfemoral aortic valve implantation.
abstract: BACKGROUND
  There is great variability for the type of anaesthesia used during TAVI, with no clear consensus coming from comparative studies or guidelines. We sought to detect regional differences in the anaesthetic management of patients undergoing transcatheter aortic valve implantation (TAVI) in Europe and to evaluate the relationship between type of anaesthesia and in-hospital and 1 year outcome.
  
  
  METHODS
  Between January 2011 and May 2012 the Sentinel European TAVI Pilot Registry enrolled 2807 patients treated via a transfemoral approach using either local (LA-group, 1095 patients, 39%) or general anaesthesia (GA-group, 1712 patients, 61%).
  
  
  RESULTS
  A wide variation in LA use was evident amongst the 10 participating countries. The use of LA has increased over time (from a mean of 37.5% of procedures in the first year, to 57% in last 6 months, p<0.01). MI, major stroke as well as in-hospital death rate (7.0% LA vs 5.3% GA, p=0.053) had a similar incidence between groups, confirmed in multivariate regression analysis after adjusting for confounders. Dividing our population in tertiles according to the Log-EuroSCORE we found similar mortality under LA, whilst mortality was higher in the highest risk tertile under GA. Survival at 1 year, compared by Kaplan-Meier analysis, was similar between groups (log-rank: p=0.1505).
  
  
  CONCLUSIONS
  Selection of anaesthesia appears to be more influenced by national practice and operator preference than patient characteristics. In the absence of an observed difference in outcomes for either approach, there is no compelling argument to suggest that operators and centres should change their anaesthetic practice.
authors.affiliation: NIHR Cardiovascular BRU, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Gianni
authors.initials: G
authors.lastname: Dall'Ara
authors.affiliation: University Hospital, Rouen, France.
authors.forename: Helene
authors.initials: H
authors.lastname: Eltchaninoff
authors.affiliation: NIHR Cardiovascular BRU, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Neil
authors.initials: N
authors.lastname: Moat
authors.affiliation: EurObservational Reasearch Progamme Department, European Society of Cardiology, Sophia-Antipolis, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Laroche
authors.affiliation: Hospital Universita Puerta de Hierro, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Goicolea
authors.affiliation: University of Rome Tor Vergata, Rome, Italy.
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Ussia
authors.affiliation: Masaryk University, University Hospital Brno, Brno, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Kala
authors.affiliation: Bern University Hospital, Bern, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Wenaweser
authors.affiliation: Silesian Centre for Heart Disease, Zabrze, Poland.
authors.forename: Marian
authors.initials: M
authors.lastname: Zembala
authors.affiliation: University Hospital, Bonn, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Nickenig
authors.affiliation: St. Thomas' Hospital, London, United Kingdom.
authors.forename: Thomas
authors.initials: T
authors.lastname: Snow
authors.affiliation: NIHR Cardiovascular BRU, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Susanna
authors.initials: S
authors.lastname: Price
authors.affiliation: Hospital Universitario de Torrejon, Madrid, Spain.
authors.forename: Eduardo Alegria
authors.initials: EA
authors.lastname: Barrero
authors.affiliation: Complejo Asistencial Universitario de Leon, Leon, Spain.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Estevez-Loureiro
authors.affiliation: Bichat Hospital, Paris, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Iung
authors.affiliation: Hospital Universitario Ramon y Cajall, Madrid, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Zamorano
authors.affiliation: Herzzentrum Leipzig Abt. Kardiologie und Angiologie, Leipzig, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.affiliation: Ospedale San Raffaele, Milan, Italy.
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
authors.affiliation: John Radcliffe Hospital, Oxford, United Kingdom.
authors.forename: Bernard
authors.initials: B
authors.lastname: Prendergast
authors.affiliation: Queen Elizabeth Hospital, Birmingham, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Ludman
authors.affiliation: Bern University Hospital, Bern, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.affiliation: Thorax Institute, Hospital Clinic, Barcelona, Spain.
authors.forename: Manel
authors.initials: M
authors.lastname: Sabate
authors.affiliation: Centre Hospitalier Universitaire (CHU) Brest, Brest, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Gilard
authors.affiliation: Institute of Cardiology, Warsaw, Poland.
authors.forename: Adam
authors.initials: A
authors.lastname: Witkowski
authors.affiliation: Hadassah-Hebrew University Medical Centre, Jerusalem, Israel.
authors.forename: Haim
authors.initials: H
authors.lastname: Danenberg
authors.affiliation: UCL de Mont-Godinne, Yvoir, Belgium.
authors.forename: Erwin
authors.initials: E
authors.lastname: Schroeder
authors.affiliation: University of Rome Tor Vergata, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Romeo
authors.affiliation: Clinico 'San Carlos' University Hospital, Madrid, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Macaya
authors.affiliation: University of Lyon, Lyon, France.
authors.forename: Genevieve
authors.initials: G
authors.lastname: Derumeaux
authors.affiliation: NIHR Cardiovascular BRU, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Alessio
authors.initials: A
authors.lastname: Mattesini
authors.affiliation: Maria Cecilia Hospital GVM Care & Research, Ettore Sansavini Health Science Foundation, Cotignola, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Tavazzi
authors.affiliation: NIHR Cardiovascular BRU, Royal Brompton Hospital, London, United Kingdom. Electronic address: c.dimario@rbht.nhs.uk.
authors.forename: Carlo
authors.initials: C
authors.lastname: Di Mario
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000379:methods* / Q000401:mortality; D000772:Anesthesia, Local / Q000379:methods* / Q000401:mortality; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D010865:Pilot Projects; D012042:Registries; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome
keywords: Anaesthesia; Aortic valve stenosis; Outcome; Transcatheter aortic valve implantation