[DEXMEDETOMIDINE SEDATION DURING TRANSCATHETER AORTIC VALVE IMPLANTATION.]

to determine the efficacy and safety of dexmedetomidinefor sedation and analgesia during transcatheter aortic valve implantation (TA VI) withfemoral access.

the study included 34 high-risk surgical patients with "critical aortic stenosis". All patients underwent TAVI with femoral access. TAVI performed under local anaesthesia: in 18 cases - with midazolam-ketamine sedetion, in 16 cases - with dexmedetomidine sedation. The depth of sedation was evaluated by Richmond agitation-sedation scale (RASS) and Ramsay scale. Assessment includes frequency of complications arising during perioperative period.

in dexmedetomidine group compared with a group of midazolam/ketamine was observed significantly greater median of sedation level with RASS and Ramsay scales (- 3.5 and -1.0, p=0,000004, 5.0 and 3.0, respectively, p=0,000001). There was a signficant decrease in rapid pacing episodes in dexmedetomidine group (p = 0.0005). In the structure of complications prevailed delirium, stroke, ventricularfibrillation. There were no significant differences in the incidence and nature of complications in the groups studied. Under midazolam/ ketamine trend toward increased incidence of delirium compared with a group of dexmedetomidine (6.16 % and 6.25 %, respectively, p =0.604). There was no significant difference in the duration of operation and anesthesia in the study groups (p=0.889, p=0.103). There were no significant differences in length of hospital-stay and in the length of ICU-stay in groups studied (p =0.243, p=0.899).

Sedation with dexmedetomidine during TA VI with femoral access demonstrates its safety and effectiveness. Dexmedetomidine provides deep level of sedation with RASS and Ramsay scales without depression of respiratory function. There is a good tolerability of operation and good conditions for long-term use of transesophageal ECHO. In the context of ECHO monitoring further reduces the need for multiple rapid pacing (p = 0.0005), which may reduce frequency of delirium in elderly patients.