General versus Local Anesthesia with Intravenous Sedation in Transcatheter Aortic Valve Implantation

Background. Monitored anesthesia care (MAC) may offer better outcomes than general anesthesia (GA) in transcatheter aortic valve implantation (TAVI). We compared TAVI outcomes between patients who received MAC versus GA. Methods. We retrospectively reviewed data from all patients (N = 659), as well as 216 propensity-matched patients, who underwent TAVI at our institution during 2014–2019. Results. MAC and GA did not differ significantly in mortality (1.6% MAC vs. 4.2% GA, $p$ = 0.05) or stroke (2.2% MAC vs. 2.4% GA, $p$ = 0.96); however, median length of stay (LOS) was shorter in the MAC group (2 d MAC vs. 7 d GA, $p$ < 0.0001). In propensity-matched patients, mortality (2.8% MAC vs. 4.6% GA, $p$ = 0.7) and stroke (3.7% MAC vs. 1.9% GA, $p$ = 0.7) did not differ significantly between groups. LOS remained shorter in the MAC group (2 d MAC vs. 7 d GA, $p$ < 0.0001). Conclusions. In this large, single-center, retrospective study, MAC was associated with shorter hospital stay after TAVI.