Local versus general anesthesia for transcatheter aortic valve implantation (TAVR) - systematic review and meta-analysis
Open Access
- 9 March 2014
- journal article
- research article
- Published by Springer Science and Business Media LLC in BMC Medicine
- Vol. 12 (1), 41
- https://doi.org/10.1186/1741-7015-12-41
Abstract
Background: The hypothesis of this study was that local anesthesia with monitored anesthesia care (MAC) is not harmful in comparison to general anesthesia (GA) for patients undergoing Transcatheter Aortic Valve Implantation (TAVR). TAVR is a rapidly spreading treatment option for severe aortic valve stenosis. Traditionally, in most centers, this procedure is done under GA, but more recently procedures with MAC have been reported. Methods: This is a systematic review and meta-analysis comparing MAC versus GA in patients undergoing transfemoral TAVR. Trials were identified through a literature search covering publications from 1 January 2005 through 31 January 2013. The main outcomes of interest of this literature meta-analysis were 30-day overall mortality, cardiac-/ procedure-related mortality, stroke, myocardial infarction, sepsis, acute kidney injury, procedure time and duration of hospital stay. A random effects model was used to calculate the pooled relative risks (RR) with 95% confidence intervals. Results: Seven observational studies and a total of 1,542 patients were included in this analysis. None of the studies were randomized. Compared to GA, MAC was associated with a shorter hospital stay (-3.0 days (-5.0 to -1.0); P = 0.004) and a shorter procedure time (MD -36.3 minutes (-58.0 to -15.0 minutes); P < 0.001). Overall 30-day mortality was not significantly different between MAC and GA (RR 0.77 (0.38 to 1.56); P = 0.460), also cardiac-and procedure-related mortality was similar between both groups (RR 0.90 (0.34 to 2.39); P = 0.830). Conclusion: These data did not show a significant difference in short-term outcomes for MAC or GA in TAVR. MAC may be associated with reduced procedural time and shorter hospital stay. Now randomized trials are needed for further evaluation of MAC in the setting of TAVR.Keywords
This publication has 34 references indexed in Scilit:
- ESC Working Group on Valvular Heart Disease Position Paper--heart valve clinics: organization, structure, and experiencesEuropean Heart Journal, 2013
- Effect of Local Anesthetic Management With Conscious Sedation in Patients Undergoing Transcatheter Aortic Valve ImplantationThe American Journal of Cardiology, 2013
- Esophageal Hematoma After Atrial Fibrillation AblationCirculation: Arrhythmia and Electrophysiology, 2012
- A cost-utility analysis of transcatheter aortic valve implantation in Belgium: focusing on a well-defined and identifiable populationBMJ Open, 2012
- Registry of Transcatheter Aortic-Valve Implantation in High-Risk PatientsNew England Journal of Medicine, 2012
- Anesthesia and Perioperative Management of Patients Who Undergo Transfemoral Transcatheter Aortic Valve Implantation: An Observational Study of General Versus Local/Regional Anesthesia in 125 Consecutive PatientsJournal of Cardiothoracic and Vascular Anesthesia, 2011
- How can we improve the interpretation of systematic reviews?BMC Medicine, 2011
- A Re-Evaluation of Random-Effects Meta-AnalysisJournal of the Royal Statistical Society Series A: Statistics in Society, 2008
- Quantifying heterogeneity in a meta-analysisStatistics in Medicine, 2002
- Meta-analysis in clinical trialsControlled Clinical Trials, 1986