Objectives: The aim of this analysis was to compare outcomes after usage of conscious sedation (CS) and general anesthesia (GA) for transfemoral transcatheter aortic valve implantation (TF-TAVI) in Germany and assess their influence on short and 1-year outcomes.
Methods: A total of 16,543 patients who received transfemoral TAVI between 2011–2014 and consecutively enrolled in GARY were analyzed. Propensity score (PS) matching was utilized to account for differences in baseline characteristics.
Results: CS was used in 8121 patients (49%) while 8422 patients (51%) received GA. 66% of TF-TAVI under CS were performed in high volume centers. Independent predictors for the use of CS were age, STS score, ASA class, previous pacemaker, pulmonary hypertension, mean pressure gradient, the year of the procedure and the number of total cases per center. After 1:1 PS matching, 2624 patients per group remained. 30-day mortality was lower with CS compared with GA (2.8 versus 4.6%, p = 0.001) while 1-year mortality was similar (14.1 versus 15.5%, p = 0.13). Both groups did not differ statistically significantly in terms of procedural success (97.8 versus 97.8%, p > 0.99), paravalvular leak ≥2° (3.9 versus 4.9%, p = 0.13) and new pacemaker implantation (20.4 versus 20.8%, p = 0.71). The use of CS was associated with less device malposition (1.5 versus 2.7%, p = 0.003), conversion to sternotomy (0.3 versus 1.4%, p < 0.001) but more vascular complications (11.1 versus 8.6%, p = 0.003).
Conclusion: TF-TAVI under CS is safe and achieves improved 30 day mortality while 1 year mortality was similar as GA. The in-hospital course was similar between CS and GA with slightly less complications with CS.
