Background 
Transcatheter aortic valve implantation(TAVI) is an well-established alternative in treating patients with severe aortic stenosis. TAVI has been mostly done under general anesthesia or sedation. However, both methods could bring considerable risks in this fragile patient group. Here we purpose using ultrasound-guided regional anesthesia in awake patient undergoing TAVI procedure.
Methods
During August, 2015 to May,2016, 13 patients whom indicated for TAVI was included. After standard monitors and invasive hemodynamic monitors were applied, ilioinguinal/iliohypogastric nerve and the femoral branch of genitofemoral nerve were identified and blocked under real-time ultrasound guidance(Fig.1,2). TAVI procedure was then proceed. All patients were sent to ICU for postoperative care.
Results
All patients tolerated the procedure well. None were converted to general anesthesia. Mean procedure time was 156±36 minutes. Mean ICU stay was 2±1.5 days. No patient has post procedural neurologic deficit.
Conclusion
 Minimal physiological disturbance, fast recovery are valuable for this fragile patient group. Awake TAVI avoids the possible physiologic disturbance of sedation towards respiratory and cardiovascular system. With ultrasound guidance, maximal analgesia could be achieved with minimal complications. Crosstalk between cardiologist, regional and cardiac anesthesiologist is important for optimize perioperative care in TAVI patients.

Awake transcatheter aortic valve implantation (TAVI) with ultrasound-guided nerve block: a case series