Conscious Sedation with Local Anesthesia Versus General Anesthesia for Patients Undergoing Transcatheter Aortic Valve Implantation: A Randomized Controlled Trial
Objectives: Transcatheter Aortic Valve Implantation (TAVI) procedure is usually performed under General Anesthesia (GA), Conscious Sedation Associated with Local Anesthesia (CSLA) or local anesthesia alone. There have been limited studies to determine which plan of anesthesia is associated with better results. The aim of the study is to assess the role of CSLA in outcome, complications, mortality, and quality of life in immediate post-procedural period (ICU and hospital stay). Design: Participants: Seventy cases of moderate to severe aortic stenosis planned for TAVI were randomized into two groups. Interventions: Group-GA: received general anesthesia and Group- CSLA: received conscious sedation combined with local anesthesia. Measurements: We recorded the intraoperative hemodynamic changes, pH, PaO2, PaCO2, need for inotropic support and need for blood products. Post-operative measurements included the need of inotropic support, prolonged respiratory support, renal dialysis, and incidence of stroke, heart block, aortic regurge as well as mortality. Results: The CSLA group showed more incidence of respiratory acidosis manifested by the increase of PaCO2 (p=0.024), less decrease in mean arterial blood pressure (p=0.028), less need for inotropic support in both intraoperative (p=0.001) and post-operative period (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 regarding the blood products consumption (p=0.587) and incidence of complications. Conclusion: The current study showed better intraoperative hemodynamic stability, less need for Perioperative inotropic support and less hospital stay despite the presence of mild acceptable respiratory acidosis in patients receiving CSLA for TAVI procedure.