An Increase in Mean Aortic Valve Gradients the Day After Transcatheter Aortic Valve Implantation: The Effects of Evolving Anesthesia Techniques

<b>Background and Objectives</b>: After transcatheter aortic valve implantation (TAVI), transvalvular gradients increase immediately following the procedure up to 24 h afterward. While factors such as anesthesia type and fluid status have been suggested as potential contributors, the underlying cause remains unclear. With advancements in TAVI techniques, there has been a shift in anesthesia protocols from general anesthesia (GA) to monitored anesthesia care (MAC). This study aimed to assess the impact of GA and MAC on the increase in transvalvular gradients observed 24 h post-TAVI. <b>Methods</b>: A retrospective, single-center analysis was conducted on patients who underwent TAVI at our institution between 2011 and 2023 (n = 744, males = 421). The patients were divided into two groups: those who received GA (n = 201) and those who received MAC (n = 543). The GA group received either inhaled anesthetics, with or without propofol infusions, or propofol infusions at a rate of ≥100 mcg/kg/min. The MAC group received bolus doses and continuous infusions of dexmedetomidine. Transvalvular gradients were compared between immediate and 24 h post-procedure echocardiograms. <b>Results</b>: The average age of patients in the GA group (78 years [IQR 71-83]) was similar to that of the MAC group (77 years [IQR 71-83]). The GA group had a higher prevalence of comorbidities at baseline. Both groups exhibited stable, normotensive blood pressure levels during the procedure, though the GA group required more vasopressors and intravenous fluid. The GA group showed a 24 h post-TAVI mean transvalvular gradient change of +5.1 mmHg [IQR 3-8.1], while the MAC group had a 24 h mean transvalvular gradient change of +5.8 mmHg [IQR 3.2-9], with no significant difference between the groups (<i>p</i> = 0.139). <b>Conclusions</b>: Despite the greater cardiovascular depressive effects and increased need for vasopressors and fluid resuscitation in the GA group, there was no significant difference in the increase in transvalvular gradients between the GA and MAC groups at 24 h post-TAVI. Further research is needed to fully understand the reasons behind the increase in gradients observed after TAVI.