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BMC Medicine
Published in: BMC Medicine 1/2014

Open Access 01-12-2014 | Research article

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

Authors: Georg M Fröhlich, Alexandra J Lansky, John Webb, Marco Roffi, Stefan Toggweiler, Markus Reinthaler, Duolao Wang, Nevil Hutchinson, Olaf Wendler, David Hildick-Smith, Pascal Meier

Published in: BMC Medicine | Issue 1/2014

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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.
Appendix
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Metadata
Title
Local versus general anesthesia for transcatheter aortic valve implantation (TAVR) – systematic review and meta-analysis
Authors
Georg M Fröhlich
Alexandra J Lansky
John Webb
Marco Roffi
Stefan Toggweiler
Markus Reinthaler
Duolao Wang
Nevil Hutchinson
Olaf Wendler
David Hildick-Smith
Pascal Meier
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2014
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/1741-7015-12-41

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