Hemodynamic Safety of Dexmedetomidine-Fentanyl Sedation During TAVI.

BACKGROUND

Transcatheter aortic valve implantation (TAVI) is an established alternative for patients with severe aortic stenosis who are unsuitable for surgical valve replace-ment. Conscious sedation is preferred to preserve spontaneous respiration and patient cooperation. Dexmedetomidine, a selective α2-adrenergic agonist, provides sedation, analgesia, and sympatholysis with minimal respiratory depression, making it suitable for high-risk TAVI patients.

METHODS

We retrospectively analyzed 53 patients who underwent TAVI under dexme-detomidine-based sedation at a single center between January and July 2025. Patients received an initial loading dose of dexmedetomidine (1 μg/kg over 15 minutes) and fen-tanyl (1 μg/kg), followed by dexmedetomidine infusion (0.2-1.2 μg/kg/h) to achieve a Ramsay Sedation Score of 3-4 and bispectral index (BIS) 70-80. Hemodynamic param-eters were recorded at baseline (T0), post-loading (T1), 10 minutes post-loading (T2), and end of procedure (T3). Hemodynamic compromise was defined as a >30% decrease in systolic or mean arterial pressure(MAP) <65 mm Hg.

RESULTS

The mean age was 76.4 ± 7.3 years, with 58.5% female; all patients were ASA III-IV. Mean arterial pressure (MAP) remained above 65 mm Hg at all time points, with the greatest decrease at T2. Systolic and MAP reductions were consistently below the 30%threshold. Postoperative complications included pacemaker implantation in 2 patients, transient contrast-induced nephropathy in 1, and temporary inotropic support in 4. No anesthesia-related respiratory complications occurred.

CONCLUSIONS

Dexmedetomidine combined with fentanyl provides safe and effective sedation for TAVI, maintaining hemodynamic stability and spontaneous respiration. This sedation protocol minimizes perioperative risks and may improve procedural safety in high-risk patients.