Conscious Sedation vs General Anesthesia in TAVR Patients

Inclusion Criteria: 1. Signed informed consent, signed Health Insurance Portability and Accountability Act (HIPAA) documentation) 2. Age over 18 years of age. 3. Women of child bearing age must have a negative urine or serum pregnancy test. 4. Clinical indication for a transfemoral aortic valve replacement. 5. English or Spanish speaking 6. No evidence of neurological impairment as defined by a NIHSS ≤ 1 and modified Rankin scale (mRS) ≤ 2 within 7 days prior to randomization. Exclusion Criteria: 1. BMI \> 40 2. Diagnosis of severe obstructive sleep apnea based on previous polysomnography, with severe defined as an apnea-hypopnea index (AHI) \>30 episodes/hr. 3. High risk for aspiration such as severe esophageal disease (e.g. achalasia, gastroparesis, etc). 4. Inability to lie supine for more than 30 minutes. 5. Marginal femoral vessels with concern for possible conversion to transapical or transaortic access. 6. Patient refusal 7. Patient involved in another research study 8. Psychiatric condition precluding ability to provide informed consent 9. History of clinical stroke within 3 months prior to randomization