Current Anesthesiology Reports

, Volume 7, Issue 3, pp 283–290 | Cite as

General Anesthesia or Monitored Anesthesia Care for Transfemoral Transcatheter Aortic Valve Implantation: Current Trends and Future Directions

  • Jan-Oliver Friess
  • Kalgini Durrer Ariyakuddy
  • Balthasar Eberle
  • Gabor ErdoesEmail author
Cardiovascular Anesthesia (J Fassl, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Cardiovascular Anesthesia


Purpose of Review The purpose of this chapter is to provide a brief review on current anesthesia techniques for transfemoral transcatheter aortic valve implantation (TF-TAVI). Recent Findings TF-TAVI has become a standard treatment option for high risk patients with severe aortic stenosis. Increasing experience with prosthetic durability and equivalent or superior outcomes of transcatheter over surgical aortic valve replacement will boost the caseload of high- and intermediate-risk patients. For TF-TAVI, general anesthesia (GA) had initially been widely preferred over local anesthesia with monitored anesthesia care (LA-MAC), but with large national practice variation. Institutional routines are changing now since evidence from large registries accrues that LA-MAC represents a feasible, safe, and economically sound alternative to GA, if no contraindications apply. Although prospective randomized TAVI anesthesia trials are lacking, observational data show that GA is associated with higher patient risk, longer procedural time, more vasopressor and transfusion requirement, and more resource use and costs, whereas periprocedural mortality is comparable or non-significantly better with LA-MAC. In summary, GA remains a robust solution for specific situations and teams. In many experienced centers, however, LA-MAC has become first choice whenever possible. Whether LA-MAC is an option should be decided upon by the anesthesiologist and the heart team in consultation with the patient, following prospectively defined decision pathways. With increasing caseload and decreasing invasiveness of TAVI technology, anesthesia providers must meet the challenge to reduce resource use and costs without compromising patient safety and satisfaction.


Transfemoral TAVI General anesthesia Sedation Vasopressor Transfusion Outcome 


Compliance with Ethical Standards

Conflict of Interest

Jan-Oliver Friess declares that he has no conflict of interest.

Kalgini Durrer Ariyakuddy declares that she has no conflict of interest.

Balthasar Eberle has received speaker’s honoraria from Medtronic.

Gabor Erdoes declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance

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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Jan-Oliver Friess
    • 1
  • Kalgini Durrer Ariyakuddy
    • 1
  • Balthasar Eberle
    • 1
  • Gabor Erdoes
    • 1
    Email author
  1. 1.Department of Anesthesiology and Pain Therapy, InselspitalUniversity Hospital Bern, University of BernBernSwitzerland

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