Transcatheter aortic valve implantation: General anesthesia using transesophageal echocardiography does not decrease...

Area of Science:

• Cardiology
• Anesthesiology
• Interventional Cardiology

Background:

• Transcatheter aortic valve implantation (TAVI) is a key treatment for severe aortic stenosis in high-risk patients.
• Anesthesia choice for TAVI, particularly conscious sedation versus general anesthesia, remains debated.
• General anesthesia (GA) with transesophageal echocardiography (TEE) guidance is hypothesized to reduce paravalvular leaks (PVLs).

Purpose of the Study:

• To compare the incidence of moderate-to-severe PVLs between TAVI performed under conscious sedation (TAVI-S) and general anesthesia (TAVI-GA).
• To test the hypothesis that TAVI-GA is not necessary to reduce moderate-to-severe PVLs in a referral center.

Main Methods:

• Retrospective observational trial conducted in a university hospital.
• Patients undergoing TAVI were divided into TAVI-S (conscious sedation) and TAVI-GA (endotracheal tube, TEE probe) groups.
• PVL assessment at 30 days using hemodynamic, fluoroscopic, and TEE measurements based on Valve Academic Research Consortium criteria.

Main Results:

• TAVI-S was performed in 168 patients (67.5%) and TAVI-GA in 81 patients (32.5%).
• No significant difference was observed in the incidence or grade of PVLs between the TAVI-S and TAVI-GA groups.

Conclusions:

• Performing TAVI under general anesthesia with TEE guidance does not result in a lower incidence of moderate or severe PVLs.
• Conscious sedation is a viable alternative for TAVI without compromising PVL outcomes.