• Cédrick Zaouter, Sara Smaili, Lionel Leroux, Guillaume Bonnet, Sébastien Leuillet, and Alexandre Ouattara.
• Department of Anaesthesia and Intensive Care II, Bordeaux University Hospital, CHU de Bordeaux, 33000 Bordeaux, France.
• Ann Card Anaesth. 2018 Jul 1; 21 (3): 277-284.

BackgroundTranscatheter aortic valve implantation (TAVI) is a valid option for patients with severe aortic stenosis judged to be at high surgical risk. For this procedure, there is no agreement on the appropriate type of anesthesia. Sedation offers several advantages, but general anesthesia (GA) leads to less paravalvular leaks (PVLs) probably because of the transesophageal echocardiography (TEE) guidance. The objective was to compare the incidence of PVL among patients receiving conscious sedation (TAVI-S) and patients receiving GA (TAVI-GA). We made the hypothesis that a referral center does not necessitate TAVI-GA to reduce the incidence of moderate-to-severe PVL.AimThe primary outcome was the incidence of moderate-to-severe PVL at 30 days after the implantation.Design And SettingThis study design was a retrospective observational trial in a university hospital.MethodsThe TAVI-S group underwent the procedure under conscious sedation. In the TAVI-GA group, an endotracheal tube and a TEE probe were inserted. After the valve deployment, PVL was assessed by hemodynamic and fluoroscopic measurements in the TAVI-S group. TEE was also used in the TAVI-GA group to evaluate the presence of PVL. When PVL was moderate or severe according to the Valve Academic Research Consortium criteria.ResultsTAVI-S and TAVI-GA were accomplished in 168 (67.5%) and 81 (32.5%) patients, respectively. Our results show no difference between the two groups regarding the incidence and grade of PVL.ConclusionPerforming TAVI under GA with TEE guidance is not associated with a lower incidence of moderate and severe PVL.

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