Conscious Sedation with Local Anesthesia versus General Anesthesia for Patients Undergoing Transcatheter Aortic Valve Implantation

Abstract

Background: Transcatheter Aortic Valve Implantation (TAVI) procedure is being performed under general anesthesia (GA), conscious sedation associated with local anesthesia (CSLA) and local anesthesia alone. There have been limited studies to determine which plan of anesthesia is associated with better results. Aim: We aimed in this study to assess the role of CSLA in outcome, complications, mortality and to assess quality of life in immediate post‐procedural period (ICU and hospital stay). Methodology: After approval of ethical committee, seventy cases of moderate to severe aortic stenosis planned for TAVI were randomized into two groups. Group‐GA: received general anesthesia and Group‐CSLA: received conscious sedation combined with local anesthesia. We measured intraoperative hemodynamic changes, pH, PaO2, PaCO2, need for inotropic support and need for blood products. Post‐operative variables were need for inotropic support, prolonged respiratory support, need for renal dialysis, and incidence of stroke, heart block, aortic regurge as well as mortality. Results: The CSLA group showed more incidence of respiratory acidosis with increase in PaCO2 (p=0.024), less decrease in mean arterial blood pressure (p=0.028), less need for inotropic support both intraoperative (p=0.001) and post‐operative (p=0.005). The CSLA patients showed less hospital length of stay (LOS) (p=0.006) and less prolonged respiratory support more than 24h (p=0.001) compared to the GA group patients. However, there was no significant difference between the two groups as regards need for blood products (p=0.587) and incidence of complications in the form of renal failure (p=0.113), heart block (p=0.756), aortic regurge (paravalvular leak) (p=0.168) and mortality (p=0.238). There was no incidence of stroke in either group. Conclusion: CSLA for TAVI patients in the current study showed better intraoperative hemodynamic stability, less need for inotropic support whether intaoperative or postoperative and less hospital LOS despite the presence of mild acceptable respiratory acidosis. So we can recommend to consider CSLA in such patients.