Comparison of local versus general anesthesia in patients undergoing transcatheter aortic valve replacement: A meta-analysis

Pedro A. Villablanca, Divyanshu Mohananey, Katarina Nikolic, Sripal Bangalore, David P. Slovut, Verghese Mathew, Vinod H. Thourani, Josep Rode's-Cabau, Iván J. Núñez-Gil, Tina Shah, Tanush Gupta, David F. Briceno, Mario J. Garcia, Jacob T. Gutsche, John G. Augoustides, Harish Ramakrishna

Research output: Contribution to journalArticle

34 Scopus citations

Abstract

Background: Transcatheter aortic valve replacement (TAVR) is typically performed under general anesthesia (GA). However, there is increasing data supporting the safety of performing TAVR under local anesthesia/conscious sedation (LA). We performed a meta-analysis to gain better understanding of the safety and efficacy of LA versus GA in patients with severe aortic stenosis undergoing TAVR. Methods and Results: We comprehensively searched EMBASE, PubMed, and Web of Science. Effect sizes were summarized using risk ratios (RRs) difference of the mean (DM), and 95% CIs (confidence intervals) for dichotomous and continuous variables respectively. Twenty-six studies and 10,572 patients were included in the meta-analysis. The use of LA for TAVR was associated with lower overall 30-day mortality (RR, 0.73; 95% CI, 0.57–0.93; P = 0.01), use of inotropic/vasopressor drugs (RR, 0.45; 95% CI, 0.28–0.72; P < 0.001), hospital length of stay (LOS) (DM, −2.09; 95% CI, −3.02 to −1.16; P < 0.001), intensive care unit LOS (DM, −0.18; 95% CI, −0.31 to −0.04; P = 0.01), procedure time (DM, −25.02; 95% CI, −32.70 to −17.35; P < 0.001); and fluoroscopy time (DM, −1.63; 95% CI, −3.02 to −0.24; P = 0.02). No differences were observed between LA and GA for stroke, cardiovascular mortality, myocardial infarction, permanent pacemaker implantation, acute kidney injury, paravalvular leak, vascular complications, major bleeding, procedural success, conduction abnormalities, and annular rupture. Conclusion: Our meta-analysis suggests that use of LA for TAVR is associated with a lower 30-day mortality, shorter procedure time, fluoroscopy time, ICU LOS, hospital length of stay, and reduced need for inotropic support.

Original languageEnglish (US)
Pages (from-to)330-342
Number of pages13
JournalCatheterization and Cardiovascular Interventions
Volume91
Issue number2
DOIs
StatePublished - Feb 1 2018

Keywords

  • general anesthesia
  • local anesthesia
  • meta-analysis
  • severe aortic stenosis
  • transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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    Villablanca, P. A., Mohananey, D., Nikolic, K., Bangalore, S., Slovut, D. P., Mathew, V., Thourani, V. H., Rode's-Cabau, J., Núñez-Gil, I. J., Shah, T., Gupta, T., Briceno, D. F., Garcia, M. J., Gutsche, J. T., Augoustides, J. G., & Ramakrishna, H. (2018). Comparison of local versus general anesthesia in patients undergoing transcatheter aortic valve replacement: A meta-analysis. Catheterization and Cardiovascular Interventions, 91(2), 330-342. https://doi.org/10.1002/ccd.27207