Transcutaneous Aortic Valve Replacement With the Edwards SAPIEN XT and Medtronic CoreValve Prosthesis Under Fluoroscopic Guidance and Local Anaesthesia Only

OBJECTIVES: To assess the feasibility of transcatheter aortic valve implantation (TAVI; Medtronic CoreValve and Edwards SAPIEN XT) under local anesthesia with only mild analgesic medication and fluoroscopic guidance.

METHODS: 461 patients underwent TAVI under local anaesthesia with lidocaine. The procedure was performed successfully in 459 of the cases. All patients were also treated with piritramide, metoclopramide hydrochloride and 62 mg dimenhydrinate. Monitoring consisted of a six-electrode, virtual 12-lead ECG, pulse oximetry, and invasive arterial pressure measurement. There was no continuous surveillance by an anesthesiologist.

RESULTS: There was no need for conversion to general anaesthesia except in four patients who required cardiopulmonary resuscitation. Conscious sedation with intravenous administration of midazolam for agitation or inotropic medication for prolonged hypotension was necessary in only seven of the 461 patients. The combined safety end point according to the Valve Academic Research Consortium consensus document was reached in 12.6%.

CONCLUSIONS: Our results show that TAVI performed under local anaesthesia with only mild analgesic medication and under fluoroscopic guidance is feasible, with good outcome comparable to published data. 

PMID: 24459291

Posted in Computed Tomography, Echo, Radiography and tagged , , , , .

One Comment

  1. See also:

    Transcatheter Aortic-Valve Replacement with a Self-Expanding Prosthesis.
    Adams DH, Popma JJ, Reardon MJ, Yakubov SJ, Coselli JS, Deeb GM, Gleason TG, Buchbinder M, Hermiller J Jr, Kleiman NS, Chetcuti S, Heiser J, Merhi W, Zorn G, Tadros P, Robinson N, Petrossian G, Hughes GC, Harrison JK, Conte J, Maini B, Mumtaz M, Chenoweth S, Oh JK; the U.S. CoreValve Clinical Investigators.
    N Engl J Med. 2014 Mar 29.
    PMID: 24678937.

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