Sedation or general anesthesia for patients undergoing transcatheter aortic valve implantation—does it affect outcome? An observational single-center study

•The research was set to assess the feasibility and safety of TAVI under sedation.•All data were retrieved from the medical records of the patients.•There was no significant difference between the 2 groups in all demographic variables.•Mortality and major postprocedural complications in patients undergoing TAVI under sedation or general anesthesia are similar.•A total of 4.7% of the patients converted to general anesthesia.•We have shown the TAVI under sedation can be as safe as general anesthesia.

Aortic stenosis is one of the most common valvular lesions. Nowadays, a new treatment is emerging: the transcatheter aortic valve implantation (TAVI). It is considered a suitable alternative for the surgical approach in selected high-risk patients. This procedure may be performed under sedation (SED) or under general anesthesia (GEA).Study ObjectiveAssess the feasibility and safety of TAVI under sedation.DesignObservational study.SettingSingle-center study conducted between the years 2009 and 2012.PatientsA total of 204 American Society of Anesthesiologists physical status 3 to 4 patients who underwent TAVI in the study period and for whom complete data were obtained were included. Demographic and periprocedural data were acquired from the patients' files. The patients were divided into SED and GEA groups.InterventionsThe study was not an interventional study.MeasurementsThe study did not include measurements.Main ResultsThe 2 groups had similar demographic characteristics and echocardiographic parameters. The rate of conversion from SED to GEA was 4.6%. The SED group received significantly less catecholamines and intravenous fluids during the procedure. The total procedural time was significantly shorter for the SED group. There was a trend toward more postprocedural pulmonary complications in the GEA group. In-hospital mortality and total length of stay were similar between the groups.ConclusionsThe results of the current study, which included a relatively large number of patients, suggest that both anesthetic modalities are safe for patients undergoing TAVI. The anesthesiologist should thus tailor the anesthetic approach to the patient, taking into account the team's experience as well as the hemodynamic status of the patient. With growing experience, our team recommends performing TAVI under SED and in selected cases under GEA.