ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Structural Interventional Cardiology
This article is part of the Research TopicRedefining Cardiovascular Care: Innovations and Challenges in Minimally Invasive and Transcatheter InterventionsView all articles
Clinical Outcomes of Monitored Anesthesia Care Versus General Anesthesia in Transfemoral Transcatheter Aortic Valve Implantation: A Single-center Retrospective Study
Provisionally accepted
- The Second Affiliated Hospital of Harbin Medical University, Harbin, China
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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 versus 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.
Keywords: transcatheter aortic valve implantation, Monitored anesthesia care, Minimalist approach, transfemoral, aortic stenosis
Received: 23 Jun 2025; Accepted: 10 Nov 2025.
Copyright: © 2025 Zhang, Chen, Zhang and Yu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Donghui Zhang, 15114575570@163.com
Bo Yu, yubodr@163.com
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