Background and Goal of Study:
Aortic stenosis is the most frequent valvular pathology in patients over 65 years of age. Surgical valvular replacement is the standard treatment (recommendation class I), however, it presents a high morbimortality. Transcatheter aortic valve implantation (TAVI) is emerging as an alternative, less invasive technique. There are two main approaches: transfemoral and transapical. The tendency to minimal invasion, together with the unnecessary use of transesophageal echocardiography  (TEE) during the transfemoral procedure, has led to a modification of the anesthetic technique.
 Our objective is to review the anesthetic management of TAVIs performed at the General Hospital of Valencia from October 2012 to the present, and compare it with the current bibliography Materials and Methods: 99 patients were reviewed, of which 82 were operated on transfemorally. Initially, the transfemoral TAVI was performed under fluoroscopic and echocardiographic control, the anesthetic technique being general anesthesia (GA) with endotracheal intubation (ETI). Since October 2015 the use of GA with laryngeal mask (LMA) (18 cases) and sedation (2) has been progressively introduced, coinciding with the abandonment of TEE by hemodynamics after acquiring more experience. Significant hemodynamic complications were recorded in 8 cases, all of them with AG and ETI Results and Discussion:
The anesthetic technique of choice in TAVI remains a matter of discussion. Sedation reduces time and costs, as well as allowing neurological monitoring. But they are procedures that occur frequently with 
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hemodynamic instability, so  the GA and ETI offers greater safety by allowing immobility, in addition to ensuring the airway. Note the role of the LMA because it avoids laryngoscopy and intubation, as well as the use of neuromuscular blockers allowing an early awakening. For this reason, it is common that at the beginning of the learning curve, in more complicated procedures or in certain groups of patients (difficult airway, obstructive sleep apnea), an AG + ETI is chosen and that the use of the ML and sedation in those cases indicate. Conclusion(s):
Despite the evolution in the learning curve of the responsible team, complications of significant repercussions sometimes arise. Therefore, the choice of anesthetic technique should be based on patient comorbidity, institutional practices and team experience.

05 / Evolution of anaesthesia management for transfemoral aortic valve implantion ir aortic stenosis. Review of cases of our center