TCT-664 Comparison of General versus Local Anesthesia in Patients Undergoing Transcatheter Aortic Valve Replacement (TAVR): A Meta-analysis

Villablanca, Pedro; Makkiya, Mohammed; Nikolić, Katarina; Wang, Kaijun; Leśniak‐Sobelga, Agata; Augoustides, John; Maldonato, Yasdet; Ramakrishna, Harish

doi:10.1016/j.jacc.2016.09.077

Cited by 6 publications

(11 citation statements)

References 6 publications

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“…While this may reflect a lower risk population over the years, operator experience and technological advancements (specifically, smaller delivery systems) may also have a role to play. 17 However, this trend was not significant in patients with PAD, and therefore, these patients remain at higher risk than their counterparts without PAD.…”

Section: T a B L Ementioning

confidence: 99%

Association of peripheral artery disease with in‐hospital outcomes after endovascular transcatheter aortic valve replacement

Mohananey

Villablanca

Gupta

et al. 2019

Cathet Cardio Intervent

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Objectives The aim of this study was to determine the prevalence of peripheral artery disease (PAD) and its association with in‐hospital outcomes after endovascular transcatheter aortic valve replacement (EV‐TAVR). Background TAVR is an established treatment for patients at prohibitive, high, or intermediate surgical risk. PAD is a significant comorbidity in the determination of surgical risk. However, data on association of PAD with outcomes after EV‐TAVR are limited. Methods Patients in the National Inpatient Sample who underwent EV‐TAVR between January 1, 2012 and September 30, 2015 were evaluated. The primary outcome was in‐hospital mortality. Results A total of 51,685 patients underwent EV‐TAVR during the study period. Of these, 12,740 (24.6%) had a coexisting diagnosis of PAD. The adjusted odds for in‐hospital mortality [OR 1.08 (95% CI 0.83–1.41)], permanent pacemaker implantation [OR 0.98 (0.85–1.14)], conversion to open aortic valve replacement [OR 1.05 (0.49–2.26)], or acute myocardial infarction [OR 1.31(0.99–1.71)] were not different in patients with versus without PAD. However, patients with PAD had greater adjusted odds of vascular complications [OR 1.80 (1.50–2.16)], major bleeding [OR 1.20 (1.09–1.34)], acute kidney injury (AKI) [OR 1.19 (1.05–1.36)], cardiac complications [aOR 1.21 (1.01–1.44)], and stroke [OR 1.39(1.10–1.75)] compared with patients without PAD. Length of stay (LOS) was significantly longer for patients with PAD [7.23 (0.14) days vs. 7.11 (0.1) days, p < 0.001]. Conclusion Of patients undergoing EV‐TAVR, ~25% have coexisting PAD. PAD was not associated with increased risk of in‐hospital mortality but was associated with higher risk of vascular complications, major bleeding, AKI, stroke, cardiac complications, and longer LOS.

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Section: T a B L Ementioning

confidence: 99%

Association of peripheral artery disease with in‐hospital outcomes after endovascular transcatheter aortic valve replacement

Mohananey

Villablanca

Gupta

et al. 2019

Cathet Cardio Intervent

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“…Exclusion criteria included the following: non-English studies, conference abstracts, proceedings, case reports and other non-comparative study designs. The citations from the literature search were compared to papers in a meta-analysis comparing MAC to GA in TAVI to ensure papers were not missed [6] .…”

Section: Systematic Literature Reviewmentioning

confidence: 99%

“…Recently, minimalist TAVI conducted under monitored anesthesia care (MAC) has gained popularity. Studies suggest that it is less invasive and allows for earlier mobilization and patient discharge without compromising early outcomes [6] . Since TEE is not usually conducted under MAC, minimalist TAVI often uses transthoracic echocardiography (TTE) instead [5] .…”

Section: Introductionmentioning

confidence: 99%

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Transthoracic vs. transesophageal echocardiography in transcatheter aortic valve implantation: a systematic review and meta-analysis

Lam¹,

Tam²,

Dixit³

et al. 2019

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Aim: Traditionally, transcatheter aortic valve implantation (TAVI) was performed under general anesthesia (GA) accompanied by intraprocedural transesophageal echocardiography (TEE). Recently, minimalist TAVI with monitored anesthesia care (MAC) and transthoracic echocardiography (TTE) has gained popularity. However, TTE imaging quality may be suboptimal compared to TEE and may increase the risks of paravalvular leak (PVL). We sought to compare TTE to TEE for PVL (primary outcome) and secondary safety outcomes in a study-level meta-analysis.Methods: Ovid versions of Medline and Embase were searched from 1946 to 2018 for studies comparing TTE to TEE in TAVI directly or MAC to GA in TAVI (must also specify echocardiography usage) and meta-analyzed in a random effects model. Results:Sixteen studies (n = 3,510) were included in the meta-analysis. The rate of any PVL was not significantly different between TTE-TAVI and TEE-TAVI groups (18.4% vs. 21.4%, risk ratio: 1.01, 95%CI: 0.83 to 1.23, P = 0.92, I 2 = 36%). Similarly, there were no significant differences in secondary safety outcomes. Resource utilization was lower with TTE-TAVI; hospital LOS [mean difference (MD): -1.55 days, 95%CI: -2.27 to -0.83, P < 0.01], contrast volume (MD: -24.75 mL, 95%CI: -49.48 to -0.03, P = 0.05) and procedure time (MD: -31.09 min, 95%CI: -54.77 to -7.40, P < 0.01) were significantly lower. Conclusion:The use of TTE-TAVI in conjunction with MAC was not associated with an increased risk of PVL and was associated with lower hospital resource utilization. However, other factors, such as mode of anesthesia, may have influenced these findings.

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“…Villablanca et al, [5] provide valuable additional insight regarding the safety and efficacy of a local anesthesia approach to TAVR (including anesthesia monitored and light sedation techniques without planned endotracheal intubation). Their meta-analysis included 26 studies representing pooled data from 10,527 patients comparing general versus local anesthesia for TAVR.…”

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confidence: 99%

Conscious sedation for TAVR: A wave of the future?

Tan

Dean

2018

Cathet Cardio Intervent

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As indications for TAVR continue to grow, experienced centers strive to adopt further minimally invasive techniques and continue to improve outcomes. Meta-analysis of the available data demonstrate that conscious sedation is associated with decreased ICU and hospitalization time, and is not associated with decreased procedural efficacy or safety. Randomized Controlled clinical Trial data will be needed to confirm observational findings suggesting decreased mortality with conscious sedation versus general anesthesia.

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TCT-664 Comparison of General versus Local Anesthesia in Patients Undergoing Transcatheter Aortic Valve Replacement (TAVR): A Meta-analysis

Cited by 6 publications

References 6 publications

Association of peripheral artery disease with in‐hospital outcomes after endovascular transcatheter aortic valve replacement

Association of peripheral artery disease with in‐hospital outcomes after endovascular transcatheter aortic valve replacement

Transthoracic vs. transesophageal echocardiography in transcatheter aortic valve implantation: a systematic review and meta-analysis

Conscious sedation for TAVR: A wave of the future?

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