A minimally invasive anaesthetic approach for transcatheter aortic valve implantation: is this really supported by the evidence?

Abstract

In association with growing operator experience and increasingly sophisticated delivery systems and valve prostheses, the anaesthetic management of patients undergoing transfemoral transcatheter aortic valve implantation (TAVI) has changed in many centres from general anaesthesia with invasive monitoring to local anaesthesia with conscious sedation or solely local anaesthesia. In a recent issue of the British Journal of Anaesthesia, a group of Italian experts in cardiac anaesthesia, cardiology, and cardiac surgery present an interdisciplinary consensus on the anaesthetic management of TAVI patients, recommending that a minimally invasive approach should be favoured in most cases. We critically evaluate the observational data supporting this consensus in comparison with the evidence from the available randomised controlled trials and highlight the need for an individual approach for anaesthetic management best suited to ensure safe and successful TAVI procedures.

Keywords: aortic valve; conscious sedation; general anaesthesia; local anaesthesia; transfemoral transcatheter aortic valve implantation.