TAVRs are frequently performed under conscious sedation, and recent trials indicate no difference in outcomes between patients randomized to general anesthesia or sedation. However, certain cases warrant general anesthesia, such as those requiring nonstandard arterial approaches (eg, transcarotid, transaxillary, or transapical access) or complex anatomy requiring TEE guidance. Large-bore central venous access is necessary, although it is often possible to utilize the femoral venous catheter placed by the proceduralists. Similarly, radial artery catheters are placed before induction of general anesthesia, but arterial pressure can also be transduced from the arterial sheaths in patients receiving conscious sedation.

TAVR has demonstrated a favorable safety profile compared to surgical AV replacement in multiple patient groups. Nonetheless, notable complications include cerebral embolism, coronary obstruction, paravalvular leaks, and conduction abnormalities (particularly following placement of self-expanding valves). In the latter circumstance, placement of a temporary transvenous pacemaker can be required.

References

• Feistritzer HJ, Kurz T, Stachel G, et al. Impact of anesthesia strategy and valve type on clinical outcomes after transcatheter aortic valve replacement. J Am Coll Cardiol. 2021;77:2204-2215.
• Neuberger PJ, Patel PA. Anesthetic techniques in transcatheter aortic valve replacement and the evolving role of the anesthesiologist. J Cardiothorac Vasc Anesth. 2017;31:2175-2182.