Feasibility and Safety of Transfemoral Aortic Valve Replacement Using Local Anesthesia in the Catheterization Suite Versus General Anesthesia in the Operation Theater.

BACKGROUND: For over a decade, transfemoral transcatheter aortic valve replacements (TF-TAVR) have been performed at the University Hospital of Nancy. A minimalistic approach to TF-TAVR, conducted without general anesthesia and entirely percutaneously in a catheterization suite (simplified approach), has been reported to be as safe and successful as the standard approach under general anesthesia in an operating room with surgical arterial cutdown. This study compares our initial experience of the simplified approach with the standard approach for TF-TAVR.

AIMS: Assessing feasibility and safety of a simplified TAVR compared with the standard approach.

METHODS: We included TF-TAVR performed from April 2020 to December 2021, and compared the simplified versus standard approach (SIMP-group n = 89 vs. STD-group n = 347). The endpoints included co-primary endpoints defined by VARC-3 (technical success at procedure exit, device success at discharge, and early safety at discharge), individual events during hospitalization, and mortality at 30 days and 1 year.

RESULTS: Baseline characteristics showed more comorbidities in the SIMP-group. There were no significant differences for mortality rates and for the three co-primary endpoints between the two groups. Bleeding and vascular complications were higher in the STD-group (7.9% vs. 17%, p = 0.036 and 6.7% vs. 16%, p = 0.031). ICU and overall hospital stays were shorter in the SIMP-group (median 1 vs. 2 days, p < 0.01 and 4 vs. 6 days, p < 0.001).

CONCLUSION: This study suggests that the simplified approach for TF-TAVR is as safe and successful as the standard approach, even for patients with greater comorbidities and operative risk. These findings could extend the simplified approach to younger, lower-risk patients, optimizing hospital resource use and reducing waiting times for TAVR.