title: Transcatheter mitral valve repair with the MitraClip(®) can be performed without general anesthesia and without conscious sedation.
abstract: BACKGROUND
  General anesthesia is known to be associated with an increased risk for complications, especially in elderly and multi-morbid patients, the primary target population of the MitraClip(®) technique. The aim is to assess whether general anesthesia and even conscious sedation can be avoided during the MitraClip(®) procedure.
  
  
  METHODS
  A total of 91 consecutive patients who underwent MitraClip(®) implantation [median 77 years, (IQR 72-83), 40 % female] were retrospectively analyzed. The first 26 patients were treated in general anesthesia. Afterwards, local anesthesia was chosen as primary anesthetic approach. Altogether, 28 (31 %) patients received general anesthesia, local anesthesia was performed in 35 (38 %) patients with sedation and in 28 (31 %) patients without sedation.
  
  
  RESULTS
  The respective patient groups were similar regarding their baseline characteristics. Procedural success (successful implantation of at least one clip and post-procedure MR grade ≤2) was achieved in 89 % with no difference between the groups (93 % in general anesthesia, 89 % in local anesthesia with sedation, 86 % in local anesthesia without sedation, p = ns). No difference regarding hospital complications was noted. Local anesthesia with and without sedation was associated with less necessity for ICU/IMC stay (100 % in general anesthesia, 14 % in local anesthesia with sedation, 14 % in local anesthesia without sedation; p < 0.0001). One-year estimated survival was not significantly different among the groups (63, 82 and 75 %; p = ns).
  
  
  CONCLUSIONS
  Transcatheter mitral valve repair with the MitraClip(®) can be performed without general anesthesia and even without conscious sedation with similar procedural success and complication rates.
authors.affiliation: CardioVascular Center CVC, Sankt Katharinen Hospital, Seckbacher Landstraße 65, 60389, Frankfurt, Germany.
authors.forename: Jakob
authors.initials: J
authors.lastname: Ledwoch
authors.affiliation: CardioVascular Center CVC, Sankt Katharinen Hospital, Seckbacher Landstraße 65, 60389, Frankfurt, Germany.
authors.forename: Predrag
authors.initials: P
authors.lastname: Matić
authors.affiliation: CardioVascular Center CVC, Sankt Katharinen Hospital, Seckbacher Landstraße 65, 60389, Frankfurt, Germany.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Franke
authors.affiliation: CardioVascular Center CVC, Sankt Katharinen Hospital, Seckbacher Landstraße 65, 60389, Frankfurt, Germany.
authors.forename: Sameer
authors.initials: S
authors.lastname: Gafoor
authors.affiliation: CardioVascular Center CVC, Sankt Katharinen Hospital, Seckbacher Landstraße 65, 60389, Frankfurt, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Bertog
authors.affiliation: CardioVascular Center CVC, Sankt Katharinen Hospital, Seckbacher Landstraße 65, 60389, Frankfurt, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Reinartz
authors.affiliation: CardioVascular Center CVC, Sankt Katharinen Hospital, Seckbacher Landstraße 65, 60389, Frankfurt, Germany.
authors.forename: Laura
authors.initials: L
authors.lastname: Vaskelyte
authors.affiliation: CardioVascular Center CVC, Sankt Katharinen Hospital, Seckbacher Landstraße 65, 60389, Frankfurt, Germany.
authors.forename: Ilona
authors.initials: I
authors.lastname: Hofmann
authors.affiliation: CardioVascular Center CVC, Sankt Katharinen Hospital, Seckbacher Landstraße 65, 60389, Frankfurt, Germany. info@cvcfrankfurt.de.
authors.forename: Horst
authors.initials: H
authors.lastname: Sievert
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000009:adverse effects; D000772:Anesthesia, Local / Q000009:adverse effects; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D016292:Procedural Sedation / Q000009:adverse effects; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000503:physiopathology; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Anesthesia; MitraClip; Mitral regurgitation; Transcatheter mitral valve repair