Original title: 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. Reference: Oguri A et al. CircCardiovascInterv. 2014; 7:602-610.

Transcatheter aortic valve replacement (TAVI) performed under local anesthesia is becoming an increasingly common procedure. This study compared clinical outcomes in patients receiving TAVI under local anesthesia versus general anesthesia.Data from 2326 patients in the French national registry of CoreValve and Edwards (FRANCE 2) who underwent TAVI via femoral access were analyzed.During theregistry period, the percentage of procedures with local anesthesia increased from 14% in January 2010 to 59% in October 2011. The results of 1377 cases performed under general anesthesia vs 949 received local anesthesia were compared.Several differences were observed in baseline characteristics of the two groups, one of the most significant was the use of trans-esophageal echocardiography during the procedure (76.3% general anesthesia versus 16.9 with local anesthesia).Successful device implantation rate and 30-day mortality were similar between the two techniques while the highest incidence of mild aortic insufficiency was significantly less frequent with general anesthesia (15% versus 19.1%; p = 0.015).The groups were also analyzed using propensity score that included the use of trans-esophageal echocardiography. This model, which left 401 patients in each group, indicated that no significant difference in the survival rate at 30 days (91.4% with general anesthesia versus 89.3% with local anesthesia; p = 0.27) as in the rate of aortic regurgitation greater than mild (12.7% with general anesthesia versus16.2%; with local anesthesia; p = 0.19).

Conclusion

The transcatheter aortic valve replacement by transfemoral approach under local anesthesia is less invasive and may be preferable in some patients although the incidence of post-procedural aortic regurgitation should be emphasized.

Editorial comment

The rate of aortic insufficiency does not seem to have been determined by the type of anesthesia after adjusting the different variables (including the use of transesophageal echocardiogram) the difference disappeared. The problem is that many patients do not tolerate the transesophageal echocardiography catheter using only local anesthesia.

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