No sedation required: Local anesthesia enough for most TAVR patients
Performing transcatheter aortic valve replacement (TAVR) with local anesthesia instead of sedation is an effective treatment strategy for a majority of patients, according to new data presented at ESC Congress 2025, the annual meeting of the European Society of Cardiology.
Researchers compared two treatment strategies. The first strategy was a more “minimalist” approach to TAVR that involved local anesthesia only and no sedation, central venous lines, additional arterial lines for blood pressure monitoring or urinary catheters. The other strategy was a more typical approach that involved sedation; central venous lines, additional arterial lines and urinary catheters were all used according to local practices.
The study’s median age was 83 years old, and nearly 60% of patients were women. Overall, the primary outcome—a composite of all-cause mortality, vascular and bleeding complications, infections requiring antibiotic treatment and neurologic events after 30 days—was seen in 22.9% of patients treated with a minimalist approach and 25.8% of patients treated with the typical standard of care. Approximately 19% of patients did cross over to the standard-care group, the authors noted, due to pain or discomfort.
“Our results indicate that around 80% of patients can be safely managed with the minimalist approach,” Prof Mohamed Abdel-Wahab, an interventional cardiologist with the Heart Center Leipzig at Leipzig University in Germany, said in a statement. “Further analyses may help to better inform in which subgroups the minimalist approach is most or least suitable.”
Comparing self-expanding TAVR valves
This study also included a separate comparison of patients treated with an Acurate neo2 TAVR valve from Boston Scientific and those treated with an Evolut Pro, Pro+ or FX TAVR valve from Medtronic. Overall, the study’s primary endpoint—a composite of all-cause mortality, stroke, prosthetic valve regurgitation and permanent pacemaker implantation (PPMI)—occurred in 15.4% of patients treated with an Acurate neo2 valve and 30.4% of patients with an Evolut valve. This was primarily driven by a much lower rate of PPMI for the Boston Scientific devices.
However, in the time since this study was planned, Boston Scientific exited the TAVR market after spending years seeking key regulatory approvals for its Acurate line of transcatheter heart valves. Abdel-Wahab noted that the significantly lower PPMI rate suggests future design teams may want to review the structure of the Acurate neo2 TAVR valve when developing the next generation of transcatheter heart valves.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.