Transfemoral TAVI under Monitored Anesthesia Care

Abstract

We have performed more than 200 transfemoral（TF）transcatheter aortic valve implantations（TAVIs）under monitored anesthesia care（MAC）. At our institution, TF-TAVIs are generally performed under MAC. In some cases, however, we intentionally choose general anesthesia（GA）or switch from MAC to GA intraoperatively. Moreover, in some cases our decision to select MAC is questionable. Dexmedetomidine is primarily used for sedation and is occasionally used with ketamine. MAC is associated with more hemodynamic stability in patients than GA, but relatively deep sedation without a secured airway can sometimes lead to severe carbon dioxide retention. Therefore, strict monitoring of respiration is mandatory. Transthoracic echocardiography, instead of transesophageal echocardiography, is used in patients undergoing MAC. However, this choice can lead to delayed detection of complications and has a limitation in evaluating the aorta.