General Anaesthesia Versus Conscious Sedation in Transcatheter Aortic Valve Implantation: Differences in Pulmonary Infections.

BACKGROUND

Patients undergoing transfemoral aortic valve replacement are particularly vulnerable and require a more sophisticated anesthetic therapeutic approach. According to the literature, no study has directly compared general anaesthesia with conscious analgosedation using postoperative infections as the primary endpoint.

METHODS

Patients undergoing transcatheter aortic valve implantation (TAVI) were analyzed retrospectively. A total of 3313 patients from a large heart center in Western Europe were included in this study. One group received general anaesthesia, and the other group received analgosedation for TAVI. The primary outcome was postinterventional pneumonia; secondary outcomes included myocardial infarction, renal failure, stroke, and 30-day mortality. Propensity score matching using 16 matching criteria yielded over 1000 pairs.

RESULTS

No difference was observed in the incidence of postinterventional pneumonia (p = 0.148). The occurrence of myocardial infarction (p = 0.2) and stroke (p = 0.4) also did not differ significantly between the two groups. In contrast, the need for transient renal replacement therapy (p = 0.02) and 30-day mortality (p = 0.02) were lower in the analgosedation group.

CONCLUSIONS

Regarding postinterventional pneumonia, general anaesthesia can be used as safely as analgosedation during TAVI. However, since renal failure requiring temporary replacement therapy and mortality are both increased with general anaesthesia, analgosedation should be the standard of care for TAVI in high-volume centers. The anesthetic regimen must be determined on an individual basis and discussed during the heart team briefing. The conversion to, or primary use of, general anaesthesia when clinically indicated is safe. Overall, ensuring the continuous presence of a senior consultant anesthetist, specifically trained in cardiac anaesthesia, throughout the procedure is essential.