Articles Vol. 67 No. 8 28/08/2026

ANESTHESIA FOR TRANSCATHETER AORTIC VALVE IMPLANTATION (TAVI/TAVR): A NARRATIVE REVIEW AND CLINICAL APPLICATION

Vu Tuan Viet1,2,3,4, Quach Minh Chinh1,2,3,4, Phan Thuy Chi1,2,3,4, Tang Thi Huong Sen1,3, Nguyen Thi Thu1,3, Le Thi Tuyet1,3, Nguyen Thu Tra1,3, Duong Thi Hoan1,2,3,4
1 Vinmec Times City Hospital
2 VinUni University
3 Bệnh viện Vinmec Times City
4 Đại học VinUni
DOI: 10.52163/yhc.v67i8.6266
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Keywords
Transcatheter Aortic Valve Implantation/Replacement, General anesthesia, Conscious sedation, Local anesthesia
Abstract

Objective: To update the current advances and recommendations on anesthesia for Transcatheter Aortic Valve Implantation (TAVI/TAVR), thereby proposing a strategy for selecting the appropriate anesthesia method in clinical practice. Methods: Information was collected from articles on PubMed, Cochrane Library using the keywords “Transcatheter Aortic Valve Implantation/Replacement” or “TAVI” or “TAVR” AND “anesthesiologic management” or “sedation” or “general anesthesia” or “local anesthesia”. The available evidence regarding anesthesia for TAVI/TAVR procedures was synthesized and analyzed to propose clinical application guidelines. Results: Local anesthesia (LA) combined with conscious sedation (CS), as well as LA alone, are currently predominant compared to general anesthesia (GA). GA still plays an important role in cases involving alternative vascular access, complex procedures (difficult valve-in-valve), uncooperative patients, or hemodynamically unstable patients. Conclusion: LA + CS or LA alone should be the preferred choice for most TAVI/TAVR cases performed via the femoral artery approach. The anesthesia selection strategy for TAVI/TAVR procedures needs to be individualized and based on the evaluation of the Heart Team.

References
[1]
Praz F, Borger MA, Lanz J, Marin-Cuartas M, Abreu A, Adamo M, et al. 2025 ESC/EACTS Guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg. 2025;67(8). doi:10.1093/ejcts/ezaf276 Google Scholar
[2]
Cribier A, Eltchaninoff H. Transcatheter Aortic Valve Implantation: Two Decades of a Revolutionary and Ongoing Odyssey. Circulation. 2024;150(11):821-2. doi:10.1161/CIRCULATIONAHA.124.068237 Google Scholar
[3]
Rosseel L, Mylotte D, Cosyns B, Vanhaverbeke M, Zweiker D, Teles RC, et al. Contemporary European practice in transcatheter aortic valve implantation: results from the 2022 European TAVI Pathway Registry. Frontiers in Cardiovascular Medicine. 2023;Volume 10 - 2023. doi:10.3389/fcvm.2023.1227217 Google Scholar
[4]
Cheng DR. Local or general anesthesia for TAVI surgery? An updated systematic review and meta-analysis. European Heart Journal. 2021;42(Supplement_1). doi:10.1093/eurheartj/ehab724.1670 Google Scholar
[5]
Jaffar-Karballai M, Al-Tawil M, Roy S, Kayali F, Vankad M, Shazly A, et al. Local versus General Anaesthesia for Transcatheter Aortic Valve Implantation (TAVI): A Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomised and Propensity-Score Matched Studies. Curr Probl Cardiol. 2024;49(3):102360. doi:10.1016/j.cpcardiol.2023.102360 Google Scholar
[6]
Feistritzer HJ, Kurz T, Vonthein R, Schröder L, Stachel G, Eitel I, et al. Effect of Valve Type and Anesthesia Strategy for TAVR: 5-Year Results of the SOLVE-TAVI Trial. J Am Coll Cardiol. 2025;85(1):74-82. doi:10.1016/j.jacc.2024.09.007 Google Scholar
[7]
Ajello V, Fresilli S, D'Amico F, Franceschini G, Aloisio T, Gottin L, et al. Management of anaesthesia for transfemoral transcatheter aortic valve implantation: an Italian interdisciplinary consensus statement. Br J Anaesth. 2026;136(3):824-35. doi:10.1016/j.bja.2025.10.052 Google Scholar
[8]
Thiele H, Kurz T, Feistritzer HJ, Stachel G, Hartung P, Lurz P, et al. General Versus Local Anesthesia With Conscious Sedation in Transcatheter Aortic Valve Implantation: The Randomized SOLVE-TAVI Trial. Circulation. 2020;142(15):1437-47. doi:10.1161/circulationaha.120.046451 Google Scholar
[9]
Mayr NP, Wiesner G, van der Starre P, Hapfelmeier A, Goppel G, Kasel AM, et al. Dexmedetomidine versus propofol-opioid for sedation in transcatheter aortic valve implantation patients: a retrospective analysis of periprocedural gas exchange and hemodynamic support. Can J Anaesth. 2018;65(6):647-57. doi:10.1007/s12630-018-1092-4 Google Scholar
[10]
Kim J-H, Nam J-S, Seo W-W, Joung K-W, Chin J-H, Kim W-J, et al. Effects of remimazolam versus dexmedetomidine on recovery after transcatheter aortic valve replacement under monitored anesthesia care: a propensity score-matched, non-inferiority study. Korean J Anesthesiol. 2024;77(5):537-45. doi:10.4097/kja.24138 Google Scholar
[11]
Feistritzer H-J, Ender J, Lauten P, Rudolph TK, Rudolph V, Geisler T, et al. Peri-Interventional Anesthesia Strategies for Transcatheter Aortic Valve Implantation: A Multicenter, Randomized, Controlled, Noninferiority Trial. Circulation. 2025;152(22):1526-37. doi:10.1161/CIRCULATIONAHA.125.076557 Google Scholar
[12]
Hasak L, Jagielak D, Lango R, Formella DM, Pepiorka-Broniecka M, Ciecwierz D, et al. Pain control with ultrasound-guided ilioinguinal-iliohypogastric nerve block compared with local infiltration anesthesia in patients undergoing transfemoral transcatheter aortic valve implantation: a prospective randomized trial. Journal of Cardiothoracic and Vascular Anesthesia. 2019;33:S86-S7. doi:: 10.1053/j.jvca.2019.07.098 Google Scholar
[13]
Lau WC, Shannon FL, Hanzel GS, Safian RD, Abbas AE, Sakwa MP, et al. Transfemoral Transcatheter Aortic Valve Replacement Using Fascia Iliaca Block as an Alternative Approach to Conscious Sedation as Compared to General Anesthesia. Cardiovasc Revasc Med. 2020;21(5):594-601. doi:10.1016/j.carrev.2019.08.080 Google Scholar
[14]
Lieppe C, Leprovost P, Jeanneteau A, Chausseret L, Pinaud F, Delepine S, et al. Transversus abdominis plane block for transcatheter aortic valve implantation under intravenous sedation: a retrospective single-center study. Minerva Anestesiol. 2022;88(3):201-3. doi:10.23736/s0375-9393.21.16143-7 Google Scholar
[15]
Sawan MA, Calhoun AE, Grubb KJ, Devireddy CM. Update on Minimalist TAVR Care Pathways: Approaches to Care in 2022. Curr Cardiol Rep. 2022;24(9):1179-87. doi:10.1007/s11886-022-01737-x Google Scholar
[16]
Nazou G, Schizas N, Romana KN, Androutsopoulou V, Magira E, Sarantopoulos A, et al. A Narrative Review on Current Status of Conscious Sedation for Transcatheter Aortic Valve Implantation. Medicina (Kaunas). 2025;61(11). doi:10.3390/medicina61111980 Google Scholar
[17]
Verolino G, Di Mauro M, Calderone D, Lorusso R. Major Intraprocedural Complications During Transcatheter Aortic Valve Implantation Requiring Emergent Cardiac Surgery: An Updated Systematic Review. American Journal of Cardiology. 2025;247:21-8. doi:10.1016/j.amjcard.2025.03.031 Google Scholar
[18]
Grube E, Sinning J-M. The “Big Five” Complications After Transcatheter Aortic Valve Replacement. JACC: Cardiovascular Interventions. 2019;12(4):370-2. doi:10.1016/j.jcin.2018.12.019 Google Scholar
[19]
Feistritzer HJ, Kurz T, Stachel G, Hartung P, Lurz P, Eitel I, et al. Impact of Anesthesia Strategy and Valve Type on Clinical Outcomes After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol. 2021;77(17):2204-15. doi:10.1016/j.jacc.2021.03.007 Google Scholar
[20]
Nguyễn Tất Bình NTT, Đặng Thị Thùy Vân,, Trần Thị Thanh Hằng TTNB, Hồ Thị Ngọc Mai, Lê Thị Tâm,, Trần Thị Ánh Hiền NTNH, Nguyễn Thị Hoài Nam. Các chiến lược gây mê cho thủ thuật cấy ghép van động mạch chủ qua đường tiếp cận xuyên đùi: một bài đánh giá tổng quan. Tạp chí Phẫu thuật Tim mạch và Lồng ngực Việt Nam. 2026;55:82 - 9. doi:10.47972/vjcts.v55i.1716 Google Scholar