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Transcutaneous aortic valve replacement with the Edwards SAPIEN XT and Medtronic CoreValve prosthesis under fluoroscopic guidance and local anaesthesia only
  1. Martin Greif1,
  2. Philipp Lange1,
  3. Michael Näbauer1,
  4. Florian Schwarz2,
  5. Christoph Becker2,
  6. Christoph Schmitz3,
  7. Tilmann Pohl1,
  8. Melvin D'Anastasi2,
  9. Peter Boekstegers4,
  10. Steffen Massberg1,
  11. Christian Kupatt1
  1. 1Medizinische Klinik und Poliklinik I, Klinikum Grosshadern, University Hospital of Munich, Munich, Germany
  2. 2Institut für Klinische Radiologie, Klinikum Großhadern, University Hospital of Munich, Munich, Germany
  3. 3Herzchirurgische Klinik, Klinikum Grosshadern, University Hospital of Munich, Munich, Germany
  4. 4Medizinische Klinik für Kardiologie und Angiologie, Helios Klinikum Siegburg, Munich, Germany
  1. Correspondence to Dr Martin Greif, Department of Cardiology, Klinikum Grosshadern, University Hospital of Munich, Marchioninistrasse 15, Munich 81377, Germany; martin.greif{at}med.uni-muenchen.de

Abstract

Objective To assess the feasibility of transcatheter aortic valve implantation (TAVI; Medtronic CoreValve and Edwards SAPIEN XT) under local anaesthesia 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 anaesthesiologist.

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.

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