title: Anaesthetic management of transcatheter aortic valve implantation: results from the Italian CoreValve registry.
abstract: OBJECTIVE
  Transcatheter aortic valve implantation (TAVI) represents a valid therapeutic alternative for patients with severe aortic stenosis at high surgical risk. However, there is no general consensus regarding the role of anaesthesia in TAVI management. The goal of this clinical project was to assess the safety and non-inferiority of local anaesthesia (LA) versus general anaesthesia (GA) in a large cohort of patients undergoing TAVI.
  
  
  RESULTS
  All 1,316 consecutive patients who underwent TAVI at seven high-volume Italian centres were enrolled. The anaesthetic regimen consisted of GA in 355 (26.9%) patients or LA in 961 (73.0%) patients. Baseline demographics were similar between the two groups except for a higher median logistic EuroSCORE (p=0.004) and peripheral artery disease (p<0.001) in the GA group. The two groups showed similar device success with no significant difference in terms of mortality, stroke and myocardial infarction. The overall procedural time was longer with the use of GA (p<0.001). The LA group showed a lower incidence of major access-site complications (p=0.01) and major (p=0.03) and life-threatening bleedings (p<0.001) with a lower occurrence of acute kidney injury stage 3 (p=0.002). Consistently, we observed a significantly shorter length of hospital stay in LA patients (8 days [7-13] vs. 7 days [6-10], GA vs. LA; p<0.001). As the GA patients were found to be at higher risk due to a higher prevalence of peripheral artery disease we carried out a propensity matching to obtain two comparable groups. This sub-analysis confirmed the same results previously observed in the overall population. As expected, in the GA group we observed longer procedural time, higher use of a surgical vascular access, higher incidence of acute kidney injury stage 3 and higher rate of bleeding and major vascular access-site complications.
  
  
  CONCLUSIONS
  Our study indicates that, in experienced centres which have gone beyond their initial learning curve with TAVI, the use of local anaesthesia in a selected patient population can be associated with good clinical outcomes. Nevertheless, as severe procedural complications are possible, an anaesthesiologist should always be present as part of the team.
authors.affiliation: Cardiac Catheterization Laboratory, Cardiothoracic Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
authors.forename: A Sonia
authors.initials: AS
authors.lastname: Petronio
authors.forename: Cristina
authors.initials: C
authors.lastname: Giannini
authors.forename: Marco
authors.initials: M
authors.lastname: De Carlo
authors.forename: Francesco
authors.initials: F
authors.lastname: Bedogni
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.forename: Silvio
authors.initials: S
authors.lastname: Klugmann
authors.forename: Arnaldo
authors.initials: A
authors.lastname: Poli
authors.forename: Fabio
authors.initials: F
authors.lastname: Guarracino
authors.forename: Marco
authors.initials: M
authors.lastname: Barbanti
authors.forename: Azeem
authors.initials: A
authors.lastname: Latib
authors.forename: Nedy
authors.initials: N
authors.lastname: Brambilla
authors.forename: Claudia
authors.initials: C
authors.lastname: Fiorina
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bruschi
authors.forename: Paola
authors.initials: P
authors.lastname: Martina
authors.forename: Federica
authors.initials: F
authors.lastname: Ettori
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000777:Anesthetics / Q000009:adverse effects; D001024:Aortic Valve Stenosis / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D006801:Humans; D015994:Incidence; D007558:Italy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012042:Registries; D012307:Risk Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000777:Anesthetics