A Novel Approach to Managing Trans-Subclavian Transcatheter Aortic Valve Replacement with Regional Anesthesia

Abstract Transfemoral transcatheter aortic valve replacement (TAVR) has evolved, through increased operator experience and technical advancements, from a procedure done routinely under general anesthesia (GA) to one that can be safely performed under conscious sedation. Although local anesthesia and conscious sedation is widely applied to transfemoral procedures, TAVR using alternative vascular access routes requiring surgical cutdown is still performed under GA. We describe the use of regional anesthesia and moderate sedation in an 82-year-old woman undergoing trans-subclavian TAVR. A pectoral (PECS-1) nerve block provided adequate anesthesia throughout the procedure and excellent post-operative analgesia with no complications.