New Practices in Transcatheter Aortic Valve Implantation: How I Do It in 2023

Abstract

Transcatheter aortic valve implantation (TAVI) went through a huge evolution in the last decades. Previously performed under general anesthesia, with transoperative transesophageal echocardiography guidance and using cutdown femoral artery access, the procedure has now evolved into a minimalist approach, with local anesthesia, conscious sedation, and the avoidance of invasive lines becoming the new standards. Here, we discuss the minimalist TAVI approach and how we incorporate it into our current clinical practice.

The association between different anesthetic techniques and outcomes in patients undergoing transfemoral aortic valve replacement

“…Currently, more centers are adopting a minimalistic approach for TAVR sedation,[ 27 ] aiming for earlier recovery to normal daily functions and next-day discharge. [ 28 ] Delayed recovery of cognitive functions after TAVR is estimated at 4.5%.…”

Patient Well-being and Satisfaction after General or Local Anesthesia with Conscious Sedation: A Secondary Analysis of the SOLVE-TAVI Trial

“…1 While most procedures were initially performed under general anesthesia, based on the assumption that avoiding general anesthesia may improve postinterventional well-being and patient satisfaction, an increasing number of procedures are now performed with local anesthesia plus conscious sedation. 2 Since this assumption, to the best of our knowledge, has never been formally proven, the primary hypothesis of this analysis was that patient well-being and patient satisfaction would be higher in patients treated with local anesthesia plus conscious sedation in comparison to general anesthesia.…”

The 10 Commandments for Transaxillary TAVI

“…9,10 Besides the choice of the ideal intervention for every patient with a specific risk profile, it is crucial to use the experience of the Heart Team members to choose the optimal access. Even if transfemoral access seems to be the first choice for most patients, 4 sometimes details like a severely kinked aorta or abdominal aneurysm can be an additional risk factor. In these cases, it might be helpful to expand the Heart Team to include a vascular surgeon to discuss the timing and necessity of the treatment for the abdominal aorta.…”

“…Furthermore, the indication for TAVI has expanded toward a larger patient population with lower calculated perioperative risk 1,2 but also to patients with a more complex patient profile. 3 Transfemoral access via the right or left common femoral artery is the predominant access route today, 4,5 despite a high prevalence of peripheral artery disease in TAVI patients. In those patients with inaccessible femoral arteries, alternative access routes have been described.…”