TAVI Anaesthetic Approach — FRCA Final MCQ

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ModerateCardiothoracic AnaesthesiaTAVI Anaesthetic ApproachFRCA Final

A 72-year-old man (ASA IV) is undergoing a TAVI (transcatheter aortic valve implantation) procedure for severe symptomatic aortic stenosis deemed inoperable by the heart team. Which anaesthetic approach is increasingly preferred for transfemoral TAVI?

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Correct answer: C — Local anaesthesia with conscious sedation

There is increasing evidence that local anaesthesia with conscious sedation (LA/CS) for transfemoral TAVI is associated with shorter procedural times, shorter ICU and hospital stays, and comparable or lower 30-day mortality compared to general anaesthesia. LA/CS avoids the haemodynamic instability of GA induction in a patient with critical AS, allows continuous neurological monitoring, and facilitates faster recovery. However, GA with transoesophageal echocardiography provides better imaging guidance and airway control, and remains necessary for transapical/transaortic approaches or complex cases.

Reference: NICE – 2017 – TA586 TAVI; ESC – 2021 – Valvular heart disease guidelines; RCOA – 2023 – Cardiac anaesthesia