Clinical outcomes of monitored anesthesia care vs. general anesthesia in transfemoral transcatheter aortic valve implantation: a single-center retrospective study

Background Transcatheter aortic valve implantation (TAVI) has become a preferred treatment for severe aortic stenosis in high-risk patients. In China, general anesthesia (GA) remains the standard; however, monitored anesthesia care (MAC) offers a less-invasive alternative. In this study, we compared the outcomes between MAC and GA in transfemoral TAVI. Methods We retrospectively analyzed the data from 106 consecutive patients (54 MAC, 52 GA) who underwent TAVI at a The Second Affiliated Hospital of Harbin Medical University from January 2021 to November 2023. MAC involved administration of a combination of local anesthesia with dexmedetomidine/remifentanil sedation, whereas GA involved endotracheal intubation. We compared procedural metrics, complications, and lengths of hospital stays. Results The baseline characteristics were comparable between the groups (mean age: 70.3 ± 7.3 years, 46% with reduced ejection fraction). The MAC group showed shorter procedure times (102 ± 25 vs. 145 ± 42 min, p < 0.0001) and hospital stays (10.5 ± 3.7 vs. 14.1 ± 5.1 days, p < 0.0001), compared with the GA group. Safety outcomes were similar between the groups: 30-day mortality (5.8% vs. 7.4% in the MAC and GA groups, respectively, p = 0.734), stroke (1.9% in both groups), and major vascular complications (3.8% vs. 5.6%). The GA group had higher valve-in-valve rates (13% vs. 1.9%, p = 0.024) and postoperative hypotension (4 vs. 0 patients), compared with the MAC group. Pacemaker implantation was more frequent in the MAC group vs. the GA group (13% vs. 3.8%, p = 0.229). Conclusions The use of MAC for TAVI is comparably safe to using GA, with potential advantages in recovery speed and resource utilization. A heart team approach, including cardiac anesthesiologists, is critical for optimal patient selection.