Transcatheter mitral valve repair with the MitraClip^® can be performed without general anesthesia and without conscious sedation

Background: General anesthesia is known to be associated with an increased risk for complications, especially in elderly and multi-morbid patients, the primary target population of the MitraClip^® technique. The aim is to assess whether general anesthesia and even conscious sedation can be avoided during the MitraClip^® procedure. Methods: A total of 91 consecutive patients who underwent MitraClip^® implantation [median 77 years, (IQR 72–83), 40 % female] were retrospectively analyzed. The first 26 patients were treated in general anesthesia. Afterwards, local anesthesia was chosen as primary anesthetic approach. Altogether, 28 (31 %) patients received general anesthesia, local anesthesia was performed in 35 (38 %) patients with sedation and in 28 (31 %) patients without sedation. Results: The respective patient groups were similar regarding their baseline characteristics. Procedural success (successful implantation of at least one clip and post-procedure MR grade ≤2) was achieved in 89 % with no difference between the groups (93 % in general anesthesia, 89 % in local anesthesia with sedation, 86 % in local anesthesia without sedation, p = ns). No difference regarding hospital complications was noted. Local anesthesia with and without sedation was associated with less necessity for ICU/IMC stay (100 % in general anesthesia, 14 % in local anesthesia with sedation, 14 % in local anesthesia without sedation; p < 0.0001). One-year estimated survival was not significantly different among the groups (63, 82 and 75 %; p = ns). Conclusions: Transcatheter mitral valve repair with the MitraClip^® can be performed without general anesthesia and even without conscious sedation with similar procedural success and complication rates.