Comparison of Two Analgosedation Regimens in Transfemoral TAVI: Propofol-Dexmedetomidine vs. Propofol-Remifentanil

Background: This study aimed to compare the hemodynamic effects of two analgosedation regimens, Remifentanil/Propofol vs. Dexmedetomidine/Propofol, during transfemoral transcatheter aortic valve implantation (tf-TAVI). Methods: In this monocentric, prospective, non-randomized observational study, 143 patients undergoing tf-TAVI between November 2021 and November 2023 were analyzed. Patients received either Remifentanil/Propofol or Dexmedetomidine/Propofol as part of their standard sedation regimen. A sensitivity analysis using propensity score matching was performed to support the primary analysis. Results: The primary outcome was circulatory stability, assessed by the need for catecholamines to maintain a mean arterial pressure (MAP) of 65 mmHg. Catecholamine use was significantly higher in the Dexmedetomidine group (78% vs. 55%; p = 0.012). No significant differences were observed in major post-procedural complications (Remifentanil: 19.05% vs. Dexmedetomidine: 13.56%; p = 0.389) or postoperative delirium scores. However, intraoperative agitation, defined as observed procedure disruption, was significantly less frequent in the Remifentanil group (33% vs. 69%; p = 0.01). Propensity score matching confirmed the robustness of these findings. Conclusion: In conclusion, both sedation strategies were associated with comparable overall clinical outcomes in patients undergoing tf-TAVI. However, our findings suggest that a tailored sedation approach may be warranted: Remifentanil–Propofol may be preferable in patients with fragile hemodynamics, whereas dexmedetomidine–propofol may represent a safer option in patients at risk for respiratory compromise. These observations support an individualized, patient-centered sedation strategy rather than a one-size-fits-all approach.