Local anesthesia during transcatheter aortic valve implantation (TAVI) was linked to fewer short-term complications but higher long-term mortality compared with sedation or conversion to general anesthesia. Findings were presented at the European Society of Cardiology (ESC) Congress 2025.

In this retrospective study of 225 patients treated at Heinrich-Heine-Universität between January and September 2022, outcomes were compared across three groups: local anesthesia alone, local anesthesia with procedural sedation, and converted anesthesia. Patients under local anesthesia experienced significantly lower rates of post-procedural delirium (P=0.006) and shorter intensive care stays, while hospitalization duration remained similar across groups.

No differences were noted in 30-day rates of myocardial infarction, stroke, or bleeding. However, at one year, patients treated under local anesthesia showed a higher incidence of major adverse cardiac and cerebrovascular events and increased mortality (P<0.001). Researchers attributed these findings partly to higher baseline comorbidities in this subgroup.

The results suggest that while awake TAVI offers short-term procedural benefits, long-term outcomes may depend heavily on patient selection and risk stratification.