O2 Tension During TAVI

Hyperoxemia can produce various complications, such as excessive oxidative stress, hyperoxia-induced vasoconstriction, increased perfusion heterogeneity, and resultant myocardial injury. Previous studies have been observed higher mortality in patient group maintained with supranormal oxygenation after resuscitation from cardiac arrest. However, the effect of hyperoxia vs. normoxia on myocardial injury during transcatheter aortic valve replacement (TAVR) has not been well investigated. We hypothesized that the normoxic group would have lower myocardial injury compared to hyperoxic group after TAVR.

• normal inspired oxygen fraction (Other): receives inspired oxygen fraction of 0.3
• high inspired oxygen fraction (Other): receives inspired oxygen fraction of 0.8

Primary outcomes

• Troponin I [72 hours after the end of procedure]: Area under the curve of troponin I

Secondary outcomes

• CK MB [72 hours after the end of procedure]: Area under the curve of CK MB
• Changes in cerebral oximetry [through procedure completion, an average of 3 hours]: changes in cerebral oximetry during the procedure
• Delirum [through admission completion, an average of 5 days]: Newly onset delirium
• AKI or RRT [through admission completion, an average of 5 days]: Newly onset acute kidney injury or renal replacement therapy
• stroke, myocardial infarction or mortality [through admission completion, an average of 5 days]: Newly onset stroke, myocardial infarction or mortality

Sex: All, ages: 20 Years to 99 Years

Inclusion Criteria:

* Scheduled for transcatheter aortic valve replacement due to aortic stenosis

Exclusion Criteria:

* Transapical approach
* Pre-procedural PaO2 < 65 mmHg or oxygen support therapy
* Pre-procedural severe kidney injury (end-stage renal disease)
* Pre-procedural chronic pulmonary disease, symptomatic asthma
* Pre-procedural Tb-destroyed lung
* Lung cancer
* History of acute coronary syndrome within 6 months
* Pre-procedural elevated Troponin I or CKMB
* History of stroke or transient ischemic attack within 6 months
* Refuse to participate
* Pregnant

• Yunseok Jeon, MD, PhD, Principal investigator, Seoul National University Hospital