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Circ Cardiovasc Interv. 2014 Aug;7(4):602-10. doi: 10.1161/CIRCINTERVENTIONS.113.000403. Epub 2014 Jul 8.

Clinical outcomes and safety of transfemoral aortic valve implantation under general versus local anesthesia: subanalysis of the French Aortic National CoreValve and Edwards 2 registry.

Author information

1
From the Centre Hospitalier Universitaire (CHU) Henri Mondor, Creteil, France (A.O., M.Y., G.M., K.C., J.-L.D.-R., E.T.); Centre Hospitalier Universitaire Brest, Brest, France (M.G.); Centre Hospitalier Universitaire Dupuytren, Limoges, France (M. Laskar); Hopital Charles Nicolle, University of Rouen, INSERM Unite 1096, Rouen, France (H.E.); Clinique Pasteur, Toulouse, France (J.F.); Bichat Hospital, Paris, France (B.I.); Insitut Jacques Cartier, Massy, France (P.D.-G.); Pitie-Salpetriere Hospital, Paris, France (P.L.); Centre Hospitalier Universitaire Rennes, Rennes, France (A.L.); Centre Hospitalier Universitaire Lille, Lille, France (A.P., E.V.B.); University Lyon 1, Lyon, France (M. Lievre); Centre Hospitalier Universitaire Besançon, Besançon, France (R.C.); and Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.).
2
From the Centre Hospitalier Universitaire (CHU) Henri Mondor, Creteil, France (A.O., M.Y., G.M., K.C., J.-L.D.-R., E.T.); Centre Hospitalier Universitaire Brest, Brest, France (M.G.); Centre Hospitalier Universitaire Dupuytren, Limoges, France (M. Laskar); Hopital Charles Nicolle, University of Rouen, INSERM Unite 1096, Rouen, France (H.E.); Clinique Pasteur, Toulouse, France (J.F.); Bichat Hospital, Paris, France (B.I.); Insitut Jacques Cartier, Massy, France (P.D.-G.); Pitie-Salpetriere Hospital, Paris, France (P.L.); Centre Hospitalier Universitaire Rennes, Rennes, France (A.L.); Centre Hospitalier Universitaire Lille, Lille, France (A.P., E.V.B.); University Lyon 1, Lyon, France (M. Lievre); Centre Hospitalier Universitaire Besançon, Besançon, France (R.C.); and Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.). masa-nori@nms.ac.jp emmanuel.teiger@hmn.aphp.fr.

Abstract

BACKGROUND:

Transcatheter aortic valve implantation (TAVI) performed under local anesthesia (LA) is becoming increasingly common. We aimed to compare the clinical outcomes in patients who underwent transfemoral-TAVI under general anesthesia (GA) and LA.

METHODS AND RESULTS:

Data from 2326 patients in the French Aortic National CoreValve and Edwards 2 (FRANCE 2) registry who underwent transfemoral-TAVI were analyzed. During the study period, the percentage of LA procedures increased gradually from 14% in January 2010 to 59% in October 2011. The clinical outcomes for GA (n=1377) and LA (n=949) were compared. Numerous baseline characteristics differed between the 2 groups, and the use of transesophageal echocardiographic guidance was more common in GA than in LA (76.3% versus 16.9%; P<0.001). Device success and cumulative 30-day survival rates were similar in the 2 groups (97.6% versus 97.0%; P=0.41 and 91.6% versus 91.3%; P=0.69, respectively), whereas the incidence of postprocedural aortic regurgitation≥mild was significantly lower in GA than in LA (15.0% versus 19.1%; P=0.015). The groups were also analyzed using a propensity-matching model, including transesophageal echocardiographic usage (GA [n=401] versus LA [n=401]). This model indicated that there were no significant differences between the 2 groups in the rates of 30-day survival (GA [91.4%] versus LA [89.3%]; P=0.27] and postprocedural aortic regurgitation≥mild (GA [12.7%] versus LA [16.2%]; P=0.19).

CONCLUSIONS:

The less invasive transfemoral-TAVI under LA is preferred in clinical settings and seems to be acceptable; however, the higher incidence of postprocedural aortic regurgitation is emphasized. Therapeutic efforts should be made to reduce such complications during transfemoral-TAVI under LA.

KEYWORDS:

anesthesia, general; anesthesia, local

[Indexed for MEDLINE]

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