Discussing the Initial Experience: Monitored Anesthesia Care vs. General Anesthesia for Trans Catheter Aortic Valve Implantation (TAVI)

The game changer in the field of treatment for Aortic Stenosis in patients with high operative risk for
surgical aortic valve replacement is Trans catheter Aortic Valve Implantation (TAVI). The aim of the
present study was to study and compare the outcome of patients among those who underwent TAVI
with general anesthesia against those who underwent TAVI with Monitored Anesthesia Care (MAC).
After institutional ethics committee approval and obtaining written informed consent, 31 patients
undergoing Trans catheter aortic valve implantation (TAVI) were registered. First 21 (n=21) (Group A)
patients who underwent TAVI at our center received general anesthesia. Subsequent 10 (n=10)
(Group B) patients who were scheduled for the procedure received sedation with dexmitidomidine.
Patient selection for TAVI was based on various risk calculators which attempts to ascertain surgical
risks. The study was carried out at a tertiary care hospital in western Maharashtra between November
2017 and March 2019. No statistically significant difference regarding pre-operative patient
characteristics, comorbidity and procedural characteristics. i.e the duration of procedure, stay in ICU,
days to discharge from procedure and duration of stay in hospital. However there are trends in favor
of monitored anesthesia case in terms of reduction in procedural time and hospital stay. TAVI can be
performed in majority of cases, under dexmitidomidine based sedation. Our initial experience
suggests that this should result in a shorter implant procedure time, reduced stay in intensive care
unit and shorter time to hospital discharge.