In 2002, Cribier et al. reported the first percutaneous transcatheter aortic valve replacement (TAVR) in a human subject. In this landmark manuscript, the authors described each step of the procedure in detail, but little was said regarding the anesthetic other than the phrase “the procedure was undertaken under mild sedation and local anesthesia.” Was an anesthesiologist present? How do we classify the anesthetic in this case, and how can we learn from what was done? Without clarity from further information, we cannot.
Overall, this study represented the first detailed analysis of anesthesia regimens in TAVR patients using the ACS NSQIP database. It examined GA and MAC techniques exclusively while excluding other forms of sedation. Despite the limitations described, the ACS NSQIP is a validated database and studying multiple datasets is prudent.
Anesthesiologists should take a lead role in studying this specialty and should be involved in development and maintenance of surgical specialty databases and quality improvement initiatives. The reliability of the data is at stake.