Clinical outcomes and safety of transfemoral aortic valve implantation under general versus local anesthesia: subanalysis of the French Aortic National CoreValve and Edwards 2 registry.

BACKGROUND: Transcatheter aortic valve implantation (TAVI) performed under local anesthesia (LA) is becoming increasingly common. We aimed to compare the clinical outcomes in patients who underwent transfemoral-TAVI under general anesthesia (GA) and LA. METHODS AND RESULTS: Data from 2326 patients in the French Aortic National CoreValve and Edwards 2 (FRANCE 2) registry who underwent transfemoral-TAVI were analyzed. During the study period, the percentage of LA procedures increased gradually from 14% in January 2010 to 59% in October 2011. The clinical outcomes for GA (n=1377) and LA (n=949) were compared. Numerous baseline characteristics differed between the 2 groups, and the use of transesophageal echocardiographic guidance was more common in GA than in LA (76.3% versus 16.9%; P<0.001). Device success and cumulative 30-day survival rates were similar in the 2 groups (97.6% versus 97.0%; P=0.41 and 91.6% versus 91.3%; P=0.69, respectively), whereas the incidence of postprocedural aortic regurgitation≥mild was significantly lower in GA than in LA (15.0% versus 19.1%; P=0.015). The groups were also analyzed using a propensity-matching model, including transesophageal echocardiographic usage (GA [n=401] versus LA [n=401]). This model indicated that there were no significant differences between the 2 groups in the rates of 30-day survival (GA [91.4%] versus LA [89.3%]; P=0.27] and postprocedural aortic regurgitation≥mild (GA [12.7%] versus LA [16.2%]; P=0.19). CONCLUSIONS: The less invasive transfemoral-TAVI under LA is preferred in clinical settings and seems to be acceptable; however, the higher incidence of postprocedural aortic regurgitation is emphasized. Therapeutic efforts should be made to reduce such complications during transfemoral-TAVI under LA.

[Surgery for aortic valve stenosis after age 80 years]. / La chirurgie des sténoses aortiques après 80 ans.

Population aging in industrialized countries and advances in surgical care are leading to an increased number of elderly patients referred for surgical management of aortic stenosis (AS). Our report is a retrospective review of 988 consecutive patients aged 80 to 93 years (mean 82.4 +/- 2.3) who had aortic valve replacement (AVR) for AS. Surgical mortality was 9.4% (93 patients). Among 895 operative survivors, follow-up rate has been 99.7%, total 4446 patient-years (mean 5 +/- 3 years, max 19 years). Actuarial survival including operative mortality was 82%, 59% and 23% at two, five and ten years respectively. Functionnal recovery was excellent (46 % NYHA I and 43% NYHA II). Long term survival paralleled that of age and sex matched control population. Age itself is no longer a contraindication to surgery and AVR is the procedure of choice for elderly patients with aortic stenosis. Percutaneous aortic valve implantation is feasible and requires evaluation. It might become an alternative for selected high-risk non surgical patients with AS.