Infrastructural prerequisites and anaesthesia standards for TF-TAVI in the participating heart centres in Germany as reported by the survey respondents
| Characteristics of the participating centres | % | n |
| TAVI procedures per year | ||
| Low-volume centre (≤300) | ||
| <50 | 5.6 | 3/54 |
| 50–300 | 50.0 | 27/54 |
| High-volume centre (>300) | ||
| 301–500 | 27.8 | 15/54 |
| >500 | 16.7 | 9/54 |
| Predominantly used anaesthesia methods | ||
| MAC favoured | 75.9 | 41/54 |
| Local anaesthesia | 9.3 | 5/54 |
| Procedural sedation | 66.7 | 36/54 |
| GA favoured | 24.1 | 13/54 |
| Approximate changeover time | ||
| <45 min | 38.9 | 21/54 |
| 45–60 min | 40.7 | 22/54 |
| >60 min | 20.4 | 11/54 |
| Preprocedural standard diagnostics | ||
| TTE | 81.5 | 44/54 |
| TOE | 72.2 | 39/54 |
| Chest X-ray | 77.8 | 42/54 |
| CT or MRI | 88.9 | 48/54 |
| Coronary angiography | 94.4 | 51/54 |
| Spirometry | 42.6 | 23/54 |
| Routine intraprocedural monitoring and instrumentation | ||
| Capnometry | 77.8 | 42/54 |
| 5-lead ECG | 85.2 | 46/54 |
| Central venous line (either CVC or introducer sheath) | 83.3 | 45/54 |
| Urinary catheter* | 64.8 | 35/54 |
| Invasive blood pressure monitoring | 98.1 | 53/54 |
| Non-invasive continuous blood pressure monitoring | 0 | 0/54 |
| Cardiac output monitoring (eg, thermodilution technique) | 0 | 0/54 |
| Bispectral index monitoring | 13.0 | 7/54 |
| Near-infrared spectroscopy | 7.4 | 4/54 |
| Pacemaker insertion | 94.4 | 51/54 |
| by anaesthetists | 43.1 | 22/51 |
| by cardiologists | 56.9 | 29/51 |
| Intraprocedural echocardiography | 51.9 | 28/54 |
| Attached defibrillator electrodes | 90.7 | 49/54 |
| Infrastructure and human resources | ||
| Anaesthesia SOP available for TF-TAVI | 90.7 | 49/54 |
| Regular Heart Team meetings | 94.4 | 51/54 |
| Routine staff in attendance during the TF-TAVI procedure | ||
| Anaesthetist | 100 | 54/54 |
| Cardiac surgeon | 77.8 | 42/54 |
| Perfusionist | 66.7 | 36/54 |
| Ready-to-use heart-lung machine available on-site | 75.9 | 41/54 |
| Preferred anaesthesia drugs | ||
| Premedication with benzodiazepines | 16.7 | 9/54 |
| Procedural sedation | ||
| Remifentanil | 56.9 | 29/51 |
| No opioid | 5.9 | 3/51 |
| Propofol | 51.0 | 26/51 |
| No hypnotic | 25.5 | 13/51 |
| General anaesthesia | ||
| Remifentanil | 68.6 | 35/51 |
| Other opioid | 27.5 | 14/51 |
| No opioid | 3.9 | 2/51 |
| Propofol | 68.6 | 35/51 |
| Inhalational anaesthetic | 31.4 | 16/51 |
| Catecholamines/Vasopressors† | ||
| Epinephrine | 29.6 | 16/54 |
| Norepinephrine | 81.5 | 44/54 |
| Dobutamine or dopamine | 13.0 | 7/54 |
| Cafedrine/Theodrenaline | 9.3 | 5/54 |
| Typical postprocedural care | ||
| Postprocedural care after GA | ||
| Extubation after transmission on ICU | 5.9 | 3/51 |
| Extubation on-site and subsequent | ||
| Transmission to ICU | 60.4 | 29/48 |
| Transmission to IMC | 35.4 | 17/48 |
| Transmission to normal ward (after postanaesthetic recovery room stay) | 4.2 | 2/48 |
| Postprocedural care after MAC‡ | ||
| ICU | 52.9 | 27/51 |
| IMC | 41.2 | 21/51 |
| Normal ward (after postanaesthetic recovery room stay) | 3.9 | 2/51 |
*One centre stated to apply urinary catheters only in women but not in men.
†Catecholamines were used as bolus application and/or continuously.
‡One centre stated that patients are transferred to ICU or IMC dependent on bed availability.
CVC, central venous catheter; GA, general anaesthesia; ICU, intensive care unit; IMC, intermediate care unit; MAC, monitored anaesthesia care; SOP, standard operating procedure; TF-TAVI, transfemoral transcatheter aortic valve implantation; TOE, transesophageal echocardiography; TTE, transthoracic echocardiography.