الفهرس 
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Abstract
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.
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).
This interventional clinical trial study was performed in Ain Shams University Hospitals. The sample size was 70 cases of Aortic Stenosis planned for TAVI, they were randomized into two groups: group (GA) received general anesthesia and comprised 33 patients and were considered the control group, and group (CSLA) received conscious sedation combined with LA and comprised 37 patients, five of them were switched to GA and were excluded from the study.
Demographic and vital data were collected and EUROSCORE II (Noyez L et al., 2012) was calculated to ensure that the per-procedural condition for both groups was similar, with the optimization of blood pressure, heart rate (HR), body temperature and chest condition.
Intraoperative data to be collected were: hemodynamic measurments represented in mean arterial blood pressure (MAP) and heart rate (HR), Arterial Blood Gases (pH, PaCO2, PaO2 and SpO2) and intra-opreative need for inotropic support.
Postoperatively, outcomes were collected: Need for inotropic support, need for prolonged respiratory support (>24h), need for renal dialysis, cerebrovascular accidents, hospital LOS, number of units of blood products needed, mortality within LOS, and any other cardiac or non-cardiac events.
Study endpoints were shifting to GA during the procedure duration, hospital LOS (discharge from hospital) and mortality during LOS,
The samples in both groups had mostly similar pre-operative conditions, and all of them had EUROSCORE II less than 20% except 2 patients in the GA group who had scores more than 20% which is a small number.
There was a significant difference between the two groups as regard Intraoperative MAP in which GA group showed decrease >20%. There was also highly significant difference in PaCO2 in which CSLA group showed higher levels. There was a significant difference in pH showing more acidosis in the CSLA group. However, there is no significant difference between the groups as regard intraoperative heart rate and PaO2.
There was a highly significant difference between the groups as regard intraoperative and ICU inotropic support in favor of the CSLA group
There was a highly significant difference between the groups as regard respiratory support, in which the CSLA group showed less need for respiratory support.
There was also a highly significant difference between the groups as regard hospital LOS in favor of the CSLA group.
There was no significant difference between the groups as regard number of blood units received.
There was no significant difference in mortality, need for renal dialysis, cerebrovascular accidents, heart block and Aortic Regurge.
So CSLA showed better intraoperative hemodynamic stability, less need for inotropic support both; intaoperative and postoperative and less hospital LOS despite the presence of mild acceptable respiratory acidosis.
So it is recommended to consider CSLA when anesthetizing patients for TAVI, and it is recommended to do further studies with larger sample sizes and better randomization. So as to further decide which anesthetic plan is better with less morbidity and mortality, and to have more evidence for better health care provision for such vulnerable patients.