Anesthesia & Clinical Research
Open Access

Abstract

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

Satish Kumar Mishra, Kamal Pathak, Ajay Swamy, Mathew Jacob, Sachin Shouche and Arijit Ghosh

Background: 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). Most TAVI have been doneunder General Anesthesia (GA) with Trans Esophageal Echocardiography (TEE). GA in this patient group ishazardous and is associated with significant complications. The aim of the present study was to study and comparethe outcome of patients among those who underwent TAVI with general anesthesia against those who underwentTAVI with Monitored Anesthesia Care (MAC).

Materials and methods: 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) patientswho were scheduled for the procedure received sedation with dexmitidomidine. Patient selection for TAVI was basedon various risk calculators which attempts to ascertain surgical risks. The study was carried out at a tertiary carehospital in western Maharashtra between November 2017 and March 2019.

Results: No statistically significant difference regarding pre-operative patientcharacteristics, comorbidity and procedural characteristics. i.e the duration of procedure, stay in ICU, days to discharge from procedure and durationof stay in hospital. However there are trends in favor of monitored anesthesia case in terms of reduction inprocedural time and hospital stay.

Conclusion: 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 unitand shorter time to hospital discharge.