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19 Local versus general anaesthesia in transcatheter aortic valve replacement – a tertiary centre experience

Introduction TAVR is conventionally performed under general anaesthesia (GA) allowing intraoperative TOE imaging. We present our experience in patients having the procedure under local anaesthesia (LA) to assess safety and length of hospital stay. Methods We retrospectively assessed all the transfemoral TAVR procedures conducted at our centre from 01/03/2011. Of 216 patients, 145 had the procedure under GA and 71 under LA. Results Both groups were similar with respect to age (80.2 vs 80.9), comorbidities, Euro Score (18.5 vs 18.8) and the severity of the aortic stenosis (AVA 0.66 vs 0.67cm2, mean/peak gradient 45.5 vs 44.2, 77.1 vs 74.5mmHg). The procedure time was significantly shorter in the LA group measured from time in room to skin closure (108 mins v 143 mins; p < 0.001). Skin open to skin closure time were the same in both groups (78 mins v 79.4 mins; p = 0.57). There was no difference in 30 day: aortic regurgitation >mild (2.1% in GA and 2.8% in LA; p = 0.744), need for permanent pacing (2.3% in GA and 1.4% in LA; P = 0.617), and cerebrovascular accidents (1.4% and 1.4%, p = 0.986). The 30 day survival was significantly different (96.5% in GA and 100% in LA; P = 0.023) as was the mean number of days in hospital (7.1 in GA and 4.6 in LA; P < 0.001). No emergency conversions to GA were performed in the LA group. Conclusions Performing a TAVR under LA is at least as safe as GA. In addition there is a reduced procedural time and length of hospital stay. LA is a safe and cost effective alternative to GA.