Comprehensive Review of Anesthesia Selection for TAVR: Comparing MAC and General Anesthesia

Abstract

Transcatheter aortic valve replacement (TAVR) has become the preferred treatment for severe symptomatic aortic stenosis, particularly in high-risk patients. This review evaluates the impact of two anesthesia approaches—general anesthesia (GA) and monitored anesthesia care (MAC) with local anesthesia (LA)—on patient outcomes during transfemoral TAVR procedures. Key outcomes assessed include 30-day mortality rates, hospital length of stay, and postoperative complications. A systematic review of 17 qualitative and quantitative studies that met predefined inclusion criteria was conducted. These studies examined the use of GA, MAC, or LA in TAVR procedures, focusing on safety and effectiveness. The analysis revealed that MAC was associated with a 30-day mortality rate of 6.9%, compared to 11.8% for GA. Additionally, MAC demonstrated potential advantages, including shorter hospital stays and fewer postoperative complications, suggesting improved procedural efficiency and enhanced recovery for patients. Although both GA and MAC remain viable anesthetic options for TAVR, MAC is emerging as a promising alternative due to its favorable impact on patient outcomes and healthcare resource utilization. However, further research is needed to evaluate long-term outcomes and optimize anesthesia protocols to ensure the best possible care for patients undergoing this increasingly prevalent procedure.