Local versus general anesthesia for transcatheter aortic valve implantation (TAVR) – systematic review and meta-analysis

Abstract

BackgroundThe 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.MethodsThis 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.ResultsSeven 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).ConclusionThese 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.

Local and general anaesthesia do not influence outcome of transfemoral aortic valve implantation

“…In the GA-group, in-hospital mortality rate was significantly higher in the high-risk tertile. the absence of differences in terms of procedure-related and 30-day mortality, stroke and MI rate, between LA/CS and GA [28]. Analysing our population according to predicted surgical risk, LA/CS did not influence clinical outcome, whereas higher mortality was observed in the high Log-EuroSCORE tertile under GA (Fig.…”

Neurologic Events After Transcatheter Aortic Valve Replacement

“…29 There has been considerable concern over the added risk of stroke for patients who require balloon postdilation of the deployed valve because of underexpansion or paravalvular leak, or for those who require more than 1 valve deployment during the procedure, with one study showing an 11.9% risk of 30-day stroke versus 2.0% (P 5 .006) for patients requiring postdilation compared with those who did not. 30 However, in subsequent studies the differences in stroke or TIA has been less dramatic.…”

Anesthesiology Experience İn Our Clinic With Patients Underwent Transcatheter Aort Valve Replacement

“…2014 yılında Fröhlich ve ark. [9] TAVR uygulaması sırasında GA ve lokal anestezi/MAC'ın karşılaştı-rıldığı ve toplamda 1542 hastanın yer aldığı, 7 göz-lemsel çalışmayı kapsayan bir meta analiz yayımladı. Bu çalışmada kısa hastane yatış süresi ve işlem süresi lokal anestezi/MAC ile ilişkili bulunmuştur.…”