Anesthesia for transcatheter aortic valve implantation in a patient with restenosed bioprosthetic aortic valve with hypersensitivity pneumonitis

Transcatheter aortic valve implantation is coming up as an alternative to surgical aortic valve replacement. This is especially helpful in patients with aortic stenosis who who are high risk for open heart surgery owing to advanced age or presence of multiple comorbidities. Local anesthesia and general anesthesia are both valid alternatives; however, depending on the patient type and cardiac function, local anesthesia with conscious sedation (LACS) appears to be a safe alternative with some added advantages. Owing to the frail constituency of typical transcatheter aortic valve implantation recipients, this transition from general anesthesia to LACS is certainly an improvement; however, even mild to moderate sedation added to local anesthesia can have deleterious effects like postoperative cognitive dysfunction, respiratory depression, delirium, and agitation on the surgical table, making the procedure even more difficult. We report one such patient who was of advanced age along with multiple comorbidities like diabetes, hypertension, hypothyroidism, and severe chronic hypersensitivity pneumonitis and was done successfully under LACS.