Background and Goal of Study: 
Transcatheter aortic valve implantation (TAVI) is a valid option for patients with severe aortic stenosis judged to be at a high surgical risk. There is still no agreement regarding the appropriate type of anaesthesia. If sedation presents several advantages, it has been suggested that general anesthesia lead to less paravalvular leaks (PVL) probably because of the transesophageal echocardiography (TEE) guidance1. The objective of this observational trial was to compare the incidence of PVL between patients receiving sedation (TAVI-S) and patients receiving general anesthesia (TAVI-GA). We hypothesized that in an experienced centre TAVI-GA does not reduce the incidence of moderate to severe PVL.

Materials and methods: 
After obtaining ethics committee approval, patient's characteristics, the incidence and grade of PVL were collected in patients undergoing TAVI. Patients in the TAVI-S group received local anesthesia on the site of the transcatheter insertion with a continuous infusion of a sedative agent. The TAVI-GA group received a total intravenous anesthesia to allow the insertion of an endotracheal tube and a TEE probe. After the valve deployment, PVL was deemed by hemodynamic and fluoroscopic measurements in the TAVI-S group. TEE was also used in the TAVI-GA group. A post-dilatation was performed when PVL was > than mild. PVL was assessed with transthoracic echocardiography in both groups on postoperative day 5.

Results and discussion: 
TAVI-S and TAVI-GA was accomplished in 168(67.5%) and in 81(32.5%) patients, respectively. The two groups were similar except for a more frequent history of coronary artery disease (p=0.004), peripheral artery disease (p< 0.001) and diabetes (p=0.028) in the TAVIGA group. Table 1 depicts the incidence and grade of PVL. A recent trial suggests that increased mortality is associated only with moderate to severe PVL2. Our results show no difference between the 2 groups in terms of PVL incidence and grade.

Conclusion: 
Our study indicates that, in an experienced center, moderate to severe PVL is rare and TAVI-GA with TEE guidance doesn't reduce it.

References:
1:Klein A&A 2014
2:Jerez-Valer JACC 2014

Transcatheter aortic valve implantation: does general anesthesia reduce the incidence of postprocedural aortic regurgitation compared to sedation?