• Hendrik Stragier, Christophe Dubois, Peter Verbrugghe, Steven Jacobs, Tom Adriaenssens, and Steffen Rex.
• Department of Anaesthesiology, University Hospitals Leuven, Leuven, Belgium. Electronic address: hendrik.stragier@gmail.com.
• J. Cardiothorac. Vasc. Anesth. 2019 Dec 1; 33 (12): 3283-3291.

ObjectiveThe objective of this study was to compare the effect of general anesthesia (GA) versus monitored anesthesia care (MAC) on post-interventional outcomes in patients undergoing transfemoral transcatheter aortic valve implantation (TAVI).DesignRetrospective before-after study using a quasi-experimental design.SettingUniversity Hospitals Leuven, a single Belgian referral center.ParticipantsPatients undergoing transfemoral TAVI from March 1, 2014, to December 31, 2017, were included.InterventionsGA was switched to MAC at the authors' institution for transfemoral TAVI in April 2016, and outcomes of patients who received GA were compared with those who received MAC.Measurements And Main ResultsThe primary outcomes were length of stay in the intensive care unit and hospital. Secondary outcomes included standardized endpoints for TAVI trials as suggested by the Valve Academic Research Consortium, the incidence of vasopressor use, maximum dose of vasopressors, procedural time, and total anesthesia time. In the period studied, 178 patients underwent transfemoral TAVI (GA: n = 85; MAC: n = 93). Implementation of MAC was associated with a significant reduction in total length of hospital stay (7.6 [6.05-9.15] v 5.48 [4.58-6.38] d; p = 0.02); vasopressor requirements; and procedural and total anesthesia time. Length of intensive care unit stay and Valve Academic Research Consortium endpoints were not significantly different.ConclusionsIn the authors' institution, implementation of MAC for patients undergoing transfemoral TAVI resulted in a significant reduction of hospital length of stay and increased operating room efficiency. Results could be confounded by increasing operator experience and improved implantation techniques.Copyright © 2019 Elsevier Inc. All rights reserved.

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