Registry data show local anesthesia safe, effective in TAVR

BARCELONA, Spain — Local anesthesia was associated with similar safety and efficacy outcomes as general anesthesia in transcatheter aortic valve replacement, according to findings from the FRANCE 2 Registry.

Romain Chopard, MD, from University Hospitals of Besançon in France, presented the data at ESC Congress.

For the study, Chopard and colleagues enrolled 3,933 adults with symptomatic severe aortic stenosis who were not candidates for surgical aortic valve replacement due to a comorbid condition. The researchers assessed 2,871 TAVR procedures performed transfemorally. Local anesthesia was used in 41.5% of the procedures, whereas general anesthesia was used in 58.5%.

The prospective, multicenter registry included participants from 33 centers in France and one location in Monaco. The study was conducted between January 2010 and December 2011.

“We observed a constant and progressive increase in the use of local anesthesia for TAVR over time in this registry,” Chopard said during a presentation. In the first 6 months of the study, local anesthesia was used in 32% of patients, which increased to nearly 50% in the final 6 months of 2011.

“We also observed that patients in the local anesthesia group presented less often with a history of coronary artery disease, pulmonary hypertension and severe aortic calcifications,” Chopard said.

Device success and in-hospital mortality rates were similar between the two groups, according to Chopard. Local anesthetic was associated with a length of hospital stay of 9 days compared with 10 days for general anesthetic.

Similar rates of death and combined safety endpoints were similar between the two groups at 20 days, according to Chopard. “At 1 year, mortality and morbidity, including stroke, hospitalization and HF, were similar between the two groups,” he said.

Chopard concluded by noting that TAVR is increasingly performed under local anesthetic in France, and possibly in many other European countries. “Our study shows that local anesthesia is as safe and effective as general anesthesia,” he said. “Local anesthesia has the advantage of being less invasive, optimizing the TAVR process [and] allowing accurate clinical assessment of the patient during the procedure. It could also potentially improve patient recovery.”

Chopard added that further study is necessary to determine the true advantages of local anesthesia. “More study can also determine which patients yield the best benefit from TAVR performed under local anesthesia,” he said. – by Rob Volansky

For more information:

Chopard R. Innovations in Cardiology. Presented at: the European Society of Cardiology Congress; Aug. 30-Sept. 3, 2014; Barcelona, Spain.

Disclosure: Chopard reports no relevant financial disclosures.