J. Fanjul- Cuesta

Background: The optimal anaesthetic strategy for transcatheter aortic valve implantation (TAVI) remains debated. We compared perioperative characteristics and early outcomes according to anaesthetic regimen: conscious sedation (CS) versus general anaesthesia (GA).Methods: Prospective observational cohort of 35 consecutive adults undergoing TAVI at a tertiary hospital with CS or GA. We collected demographics, cardiovascular and anaesthetic variables, periprocedural complications, conversion from CS to GA, intensive care unit (ICU) and hospital length of stay, 30-day mortality, and patient-reported comfort assessed in the post-procedure period (visual analogue scale, VAS). Groups were compared using standard statistical tests.Results: GA was used in 24 patients (68.6%) and CS in 11. Median age was 82.5 (IQR 81.0-86.8) years in the GA group and 82.0 (79.0-86.0) years in the CS group. Conversion from CS to GA occurred in 15.4% of patients planned for CS. There were no significant between-group differences in baseline demographics, preoperative characteristics, cardiovascular or anaesthetic parameters, ICU or hospital length of stay, or 30-day mortality (p>0.05). Patient-reported comfort was high with both techniques at 24 hours post-procedure; however, at the same 24-hour time point, VAS scores indicated greater discomfort with GA both at rest (p=0.023) and after mobilisation (p=0.019), post-procedure.Conclusions: In this single-centre cohort, no significant differences were found in perioperative parameters or early outcomes between CS and GA for TAVI. However, a non-negligible risk of conversion from CS to GA should be anticipated. Patient comfort favoured CS.