title: Bispectral index-guided sedation in transfemoral transcatheter aortic valve implantation: a retrospective control study.
abstract: OBJECTIVE
  Transcatheter aortic valve implantation (TAVI) is a minimally invasive therapy for elderly patients with severe aortic valve stenosis who were refused surgical aortic valve replacement because of the high perioperative risk. Traditionally, this procedure has been done under general anesthesia, but more recently local anesthesia and sedation have become popular. This research assessed the effectiveness of transfemoral TAVI under bispectral index (BIS)-guided sedation.
  
  
  METHODS
  In this single-center retrospective control analysis, clinical data, including demographic characteristics, echocardiography, periprocedural data, and main complications, were collected and assessed in 113 patients undergoing TAVI through the femoral artery under general anesthesia (GA group, n=36) and under BIS-guided sedation (SED group, n=77).
  
  
  RESULTS
  The demographic characteristics and echocardiographic parameters between the two groups were similar (P>0.05). Two (2.6%) of patients were moved from BIS-guided sedation to general anesthesia for surgical reasons. Procedures were significantly shorter in the SED group than in the GA group ((127.10±44.43) min vs. (165.90±71.62) min, P=0.004). Patients in the SED group lost less blood and received significantly fewer red blood cells and catecholamines than those in the GA group (5.19% vs. 22.22%, P=0.017 and 67.53% vs. 97.22%, P<0.001). The length of hospital stay was significantly shorter and there were fewer pulmonary complications in the SED group than in the GA group. Thirty-day mortality was similar between the two groups.
  
  
  CONCLUSIONS
  BIS-guided sedation is a feasible and safe approach for transfemoral TAVI. The anesthesiologist should choose the best anesthetic method according to the team's experience.
authors.affiliation: Department of Anesthesia, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.
authors.forename: Wei
authors.initials: W
authors.lastname: He
authors.affiliation: Department of Anesthesia, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.
authors.forename: Rong-Rong
authors.initials: RR
authors.lastname: Huang
authors.affiliation: Department of Anesthesia, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.
authors.forename: Qing-Yu
authors.initials: QY
authors.lastname: Shi
authors.affiliation: Department of Cardiology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.
authors.forename: Xian-Bao
authors.initials: XB
authors.lastname: Liu
authors.affiliation: Department of Cardiology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.
authors.forename: Jian-An
authors.initials: JA
authors.lastname: Wang
authors.affiliation: Department of Anesthesia, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.
authors.forename: Min
authors.initials: M
authors.lastname: Yan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000379:methods; D001024:Aortic Valve Stenosis / Q000601:surgery; D016063:Blood Loss, Surgical; D056805:Consciousness Monitors; D054810:Deep Sedation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods; D061646:Operative Time; D012189:Retrospective Studies; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*
keywords: Transcatheter aortic valve implantation; Sedation; Bispectral index