How to Move Toward the Least Invasive Transfemoral Transcatheter Aortic Valve Implantation Procedure?
In this issue of Circulation: Cardiovascular Interventions, 2 articles are published that merit our attention because they stimulate our thinking about how to improve the execution of transcatheter aortic valve implantation (TAVI).1,2 Every treatment should be evaluated from a patient’s perspective, namely, it should deliver or increase health (ie, efficacy) without doing harm (ie, safety). One may also argue that every treatment—whatever its nature—should be as comfortable to a patient as possible without compromising the 2 basic principles (safety and efficacy). From a health economic perspective, treatment should be cost effective. These 2 articles, which focus on the methods of anesthesia and of femoral arterial access in patients undergoing TAVI, indicate that less invasive strategies studied may indeed fulfill all of the above premises.
Article see p 570, 602
Oguri et al1 evaluated the temporal change away from general anesthesia (GA) and toward local anesthesia (LA) during transfemoral TAVI and the clinical implications of this transition. For that purpose, they used the data set of the French Aortic National CoreValve and Edwards (FRANCE 2) Registry that included 2326 patients who underwent transfemoral TAVI via GA (n=1377) or LA (n=949) with the Medtronic Corevalve System (n=839) or the Edwards Sapien valve (n=1487) between January 2010 and October 2011.
Accepting the inherent limitations of a nationwide registry, as acknowledged by authors—only mortality was independently adjudicated, all other events were self-reported—in addition to imbalances in baseline characteristics of the GA and LA populations, as well as time bias and, therefore, the effect of experience (GA was used mainly in the early phase and was gradually replaced by …