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7, 8 It is noteworthy that emergency conversion to general anaesthesia for TAVI-S has been reported in up to 17% of patients. 3–6 Simplified monitoring, shortened procedure time, less haemodynamic instability, a decreased need for catecholamine therapy and shorter intensive care unit (ICU) stays were presented as benefits.
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A shift from general anaesthesia (TAVI-GA) towards sedation (TAVI-S) has been increasingly described. Since 2002 transfemoral transcatheter aortic valve implantation (TAVI) 1 has continuously evolved with different approaches and techniques, 2 for treatment of severe aortic valve stenosis. Moderate to deep sedation for TAVI has potential disadvantages compared with general anaesthesia. The incidence of adverse events, principally pain and respiratory depression, was much higher in the sedation group. There were no differences in cerebral oxygenation or neurocognitive outcome. This small study compared moderate to deep sedation using propofol and remifentanil with general anaesthesia. Patients undergoing Transcatheter aortic valve implantation (TAVI) can be managed using sedation techniques or general anaesthesia.
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The higher incidence of adverse events in the sedation group suggests a potential advantage of general anaesthesia.Ĭlinical trial registration. Based on primary outcome, both methods were shown to be comparable. Cerebral desaturation occurred in both patient groups, but there was no significant difference between the two groups. Bradypnoea ( n =16, 52%) and the need for airway manoeuvres ( n =11, 36%) or bag-mask-ventilation ( n =6, 19%) were the most common respiratory adverse events.Ĭonclusions. Adverse events were more frequently observed in TAVI-S patients ( P <0.001). Neurocognitive function did not change within and between groups. Cumulative cerebral desaturation was comparable (TAVI-GA:(median ) (0 s%) vs. In 24 patients (39%) cerebral desaturation was observed. Baseline characteristics were comparable. Of 66 included patients, 62 (TAVI-GA: n =31, TAVI-S: n =31) were finally analysed. As secondary outcomes, changes in neurocognitive function and respiratory and haemodynamic adverse events were evaluated. Primary outcome was the perioperative cumulative cerebral desaturation. Near-Infrared-Spectroscopy was used to monitor cerebral-oxymetry blinded. Monitoring and anaesthetic drugs were standardized. Comparable operative risk was determined from risk-scores (EUROscore, STS-Score). Sixty-six patients (68–94 yr) with acquired aortic stenosis undergoing transfemoral CoreValve™ were assigned to TAVI-GA or TAVI-S. The INSERT trial was a single centre, controlled parallel-group trial with balanced randomization. Although general anaesthesia (TAVI-GA) and sedation (TAVI-S) have previously been described for TAVI, the difference in safety and efficacy of both methods has not been studied in a randomized trial. Transcatheter aortic valve implantation (TAVI) is a treatment strategy for patients with severe aortic stenosis.