Long-Term Survival of Patients Undergoing Transcatheter Aortic Valve Implantation Under General Anesthesia Versus Monitored Anesthesia Care.

OBJECTIVES: This study aimed to evaluate the long-term survival of patients who underwent transcatheter aortic valve implantation (TAVI) by general anesthesia (GA) versus monitored anesthesia care (MAC). DESIGN: Retrospective (observational) study. SETTING: Single center. PARTICIPANTS: Between 2015 and 2024, a total of 1,390 patients with severe aortic valve stenosis underwent TAVI with GA or MAC. INTERVENTIONS: Transcatheter aortic valve implantation by the transfemoral approach. MEASUREMENTS AND MAIN RESULTS: GA was used in 508 patients and MAC in 882 patients. The 30-day mortality was 1.6% (8 patients) in GA versus 0.6% (5 patients) in MAC (p = 0.08). Kaplan-Meier analysis showed that survival at 1, 3, 5, and 7 years was 91.1%, 75.6%, 59.8%, and 40% in GA versus 93.2%, 75.5%, 63.2%, and 46.9% in MAC, respectively (p = 0.16). Multivariable analysis using a Cox proportional hazards model demonstrated that anesthetic management with GA versus MAC (adjusted for age, sex, coronary artery disease, previous percutaneous intervention, EuroSCORE II, postprocedural cerebral vascular accident, permanent pacemaker implantation, valve-in-valve TAVI, and TAVI period) did not significantly affect the long-term survival of patients after TAVI (hazard ratio, 0.94, 95% CI, 0.74-1.18; p = 0.58). CONCLUSIONS: Anesthetic management with GA or MAC did not affect the long-term survival of patients after TAVI.