Comparative Efficacy of Local and General Anesthesia for Transcatheter Aortic Valve Implantation: A Meta-Analysis and Systematic Review

Abstract

Background: This meta-analysis aimed to compare the potential effects of local anesthesia (LA) and general anesthesia (GA) for transcatheter aortic valve implantation (TAVI). Measurements: All relevant studies were searched from Pubmed, EMbase, Web of Science, and the Cochrane Library (January 1, 2016, to June 1, 2021). The main outcomes of this literature meta-analysis were 30-day mortality, procedural time, new pacemaker implantation, total stay in the hospital, use of the vasoactive drug, and intra-and postoperative complications and emergencies, including conversion to open, myocardial infarction, pulmonary complication, vascular complication, renal injury/failure, stroke, transesophageal echocardiography, life-threatening/major bleeding, cardiac tamponade, and emergency PCI. Pooled risk ratio (RR) and mean difference (MD) together with a 95% confidence interval (CI) were calculated. Results: A total of 17 studies, including 20938 patients, in the final analysis, fulfilled the inclusion criteria. Intra-and postoperative complications (myocardial infarction, vascular complication, renal injury/failure, stroke, and cardiac tamponade) undergoing TAVI in severe AS patients under GA do not offer a significant difference compared with LA. No differences were observed between LA and GA for new pacemaker implantation, total stay in the hospital, transesophageal echocardiography, and emergency PCI. LA has lower mortality compared with GA (RR 0.69, P = 0.600), pulmonary complications (RR 0.54, P = 0.278), life-threatening/major bleeding (RR 0.85, P = 0.855), and lower times of conversion to open (RR 0.22, P = 0.746). LA has many advantages, including a shorter procedure duration (MD=-0.38, P = 0.000) and reduction of the use of the vasoactive drug (RR 0.57, P = 0.000). Conclusions: For TAVI, both LA with or without sedation and GA are feasible and safe. LA appears a feasible alternative to GA for AS patients undergoing TAVI.

Conscious sedation/monitored anesthesia care versus general anesthesia in patients undergoing transcatheter aortic valve replacement: A meta-analysis

“…Furthermore, an apparently paradoxical finding in the current meta-analysis was the significant but weak evidence showing a shorter procedural time associated with the use of CS/MAC compared to GA. Similarly, two previous meta-analyses have also demonstrated a shorter procedural time with local anesthesia compared to GA ( 14 , 15 ). One possible explanation may be a coincidence between the learning curve of the TAVR procedure and the choice of anesthesia strategy.…”

“…Results of prior studies regarding the influence of anesthetic approaches for TAVR on medical resource utilization remain inconsistent. Although a previous meta-analysis on 10,572 patients from 26 studies reported that the use of local anesthesia was associated with a shorter hospital LOS (i.e., 2.09 days) and ICU LOS (i.e., 0.18 days) ( 14 ), another recent meta-analysis of 17 studies involving 20,938 patients found no significant difference in the length of total hospital stay between patients receiving local anesthesia and those undergoing GA ( 15 ). Our results revealed a shorter ICU LOS (weak evidence) and hospital LOS (strong evidence) with the use of CS/MAC compared to GA.…”

“…There have been accumulating data from observational studies regarding the benefits and safety among different anesthetic approaches (i.e., GA vs. CS/MAC vs. local anesthesia) for TAVR. Two previous meta-analyses investigating the application of local anesthesia as the main anesthetic strategy reported an association of using local anesthesia with a lower mortality rate compared to that with GA (14,15), but one recent RCT showed no significant difference in 30-day mortality between patients undergoing TAVR with local anesthesia/CS and those receiving GA (16). Our results suggested that the use of CS/MAC may be associated with a lower risk of 30-day and one-year mortality compared with GA.…”

“…Nevertheless, the impact of different anesthetic approaches on prognostic outcomes (e.g., 30-day mortality rate) in patients undergoing TAVR remains inconsistent. While two meta-analyses of observational studies ( 14 , 15 ) reported a lower 30-day mortality with the use of local anesthesia as the main anesthetic strategy compared to that with GA, a recent randomized controlled trial (RCT) demonstrated no difference in mortality between patients receiving GA and those undergoing local anesthesia/CS ( 16 ).…”

Comparison of Safety and Effectiveness of Local or General Anesthesia after Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis

“…A number of studies [ 56 , 57 , 58 ] have found no significant difference in 30-day mortality between the above two anesthetic strategies for TAVI patients. A previous meta-analysis [ 59 ] pointed out that the anesthesia method did not influence the average 30-day mortality rate, which was 100/1532 patients in the LA group and 114/2061 patients in the GA-group [RR = 0.91, 95% CI (0.53, 1.56), p = 0.72].…”