title: Outcome After General Anesthesia Versus Monitored Anesthesia Care in Transfemoral Transcatheter Aortic Valve Replacement.
abstract: OBJECTIVE
  To evaluate outcomes of monitored anesthesia care (MAC) compared with general anesthesia (GA) in patients undergoing transfemoral transcatheter aortic valve replacement (TAVR).
  
  
  METHODS
  Secondary analysis from the observational and prospective OBSERVANT (OBservational Study of Effectiveness of avR-taVi procedures for severe Aortic steNosis Treatment) study.
  
  
  METHODS
  Multicenter study, including Italian hospitals performing TAVR interventions.
  
  
  METHODS
  One thousand four hundred ninety-four patients with severe and symptomatic aortic stenosis.
  
  
  METHODS
  Transfemoral TAVR under general or local anesthesia.
  
  
  RESULTS
  A propensity score procedure was applied, and 310 pairs were matched with similar baseline characteristics (EuroSCORE II: local anesthesia 6.6±5.9% v general anesthesia 7.0±7.7%, p = 0.430). MAC was associated with similar 30-day mortality compared with GA (3.9% v 4.8%, p = 0.564). TAVR was performed under MAC without any increased risk of other adverse events. The risk of paravalvular regurgitation≥mild was similar between the study groups (MAC 49.5% v general anesthesia 57.0%, p = 0.858). Two patients receiving on MAC had severe paravalvular regurgitation, whereas this complication was not observed after GA. Permanent pacemaker implantation was 19.1% in the MAC group v 14.8% in the GA group (p = 0.168). Mean intensive care unit stay was 3.5 days for the GA group v 2.9 days for the MAC group (p = 0.086). A similar 3-year survival rate was observed (MAC 69.4% v GA 69.9%, p = 0.966).
  
  
  CONCLUSIONS
  Transfemoral TAVR can be performed under MAC with similar immediate and late outcomes as compared with GA. A possible risk of severe paravalvular regurgitation and pacemaker implantation with TAVR under MAC requires further investigation.
authors: National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy.
authors: Paola
authors: P
authors: D'Errigo
authors: Department of Cardiothoracic and Vascular Anesthesia and ICU-IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
authors: Marco
authors: M
authors: Ranucci
authors: Department of Anesthesia and Intensive Care, Ospedale di Busto Arsizio, Varese, Italy.
authors: Remo Daniel
authors: RD
authors: Covello
authors: Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors: Fausto
authors: F
authors: Biancari
authors: National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy. Electronic address: stefano.rosato@iss.it.
authors: Stefano
authors: S
authors: Rosato
authors: Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors: Marco
authors: M
authors: Barbanti
authors: Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy.
authors: Francesco
authors: F
authors: Onorati
authors: Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors: Corrado
authors: C
authors: Tamburino
authors: Division of Cardiology, Careggi Hospital, Florence, Italy.
authors: Gennaro
authors: G
authors: Santoro
authors: Division of Cardiac Surgery, ASO S. Croce e Carle, Cuneo, Italy.
authors: Claudio
authors: C
authors: Grossi
authors: Division of Cardiac Surgery, IRCCS University Hospital San Martino IST Genova, Genova, Italy.
authors: Francesco
authors: F
authors: Santini
authors: Department of Epidemiology, Lazio Regional Health Service, Rome, Italy.
authors: Katia
authors: K
authors: Bontempi
authors: Department of Epidemiology, Lazio Regional Health Service, Rome, Italy.
authors: Danilo
authors: D
authors: Fusco
authors: Division of Cardiac Surgery, ASO S. Croce e Carle, Cuneo, Italy.
authors: Fulvia
authors: F
authors: Seccareccia
mesh_terms: D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000379:methods*; D000772:Anesthesia, Local / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007558:Italy; D007902:Length of Stay; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods*; D057216:Propensity Score; D011446:Prospective Studies; D015996:Survival Rate; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome
keywords: TAVI; TAVR; aortic valve stenosis; general anesthesia; local anesthesia; minimalist approach; monitored anesthesia care; transcatheter aortic valve replacement