Author + information
- Pedro Villablanca1,
- Mohammed Makkiya2,
- Katarina Nikolic3,
- Kaijun Wang4,
- Agata Leśniak-Sobelga5,
- John Augoustides6,
- Yasdet Maldonato7 and
- Harish Ramakrishna8
- 1Montefiore Medical Center, New York, New York, United States
- 2montefiore, Bronx, New York, United States
- 3Mayo Clinic Arizona
- 4St. Luke's Mid America Institute
- 5Department of Cardiac And Vascular Diseases, John Paul II Hospital, Kraków, Poland
- 6Interventional Cardiology Unit, University of Palermo, Palermo Italy
- 7Bristol Heart Institute
- 8Mayo Clinic, Phoenix, Arizona, United States
Transcatheter Aortic Valve Replacement (TAVR) is typically performed under general anesthesia with endotracheal intubation (GA). There is growing data in the literature however, that this procedure can be safely performed under local anesthesia (LA).
We performed a comprehensive search of EMBASE, PUBMED, and Web of Science databases. Odds ratios (OR), difference of the mean (DM) and 95% confidence intervals (CI) were computed using the Mantel-Haenszel method. Fixed-effect model was used; if heterogeneity (I2)>40, effects were obtained using a random model. Sensitivity and cumulative analysis was performed for each outcome.
A total of 18 studies and 19 255 patients were included in meta-analysis. The use of GA for TAVR was associated with an increased overall 30- day mortality (RR 1.35, Cl 1.07-1.70), length of stay (DM 2.33, CI 1.28-3.38), ICU stay (DM 8.98, CI 1.47-16.50), procedural time (DM 24.46, CI 16.52-32.41), use of vasopressors/inotropes (RR 1.95, CI 1.58-2.40), vascular complications (RR 1.41, CI 1.05-1.89) and post procedural intubation (RR 32.71, CI 18.18-58.88). TAVR with GA showed a lower incidence of paravalvular leak (RR 0.8, CI 0.66-0.80). No difference was observed between GA and LA for stroke (RR 1.15, Cl 0.91-1.45), cardiovascular mortality (RR 1.32, Cl 0.83-2.10), permanent pacemaker implantation (RR 1.32, Cl 0.83-2.10),vascular complications (RR 1.11, Cl 0.84-1.46),major bleeding (RR 1.09, Cl 0.70-1.68), acute kidney injury (RR1.07, CL 0.69-1.65), myocardial infarction (RR 0.72, Cl 0.39-1.33), procedural success (RR 1.01, CL 0.96-1.06),conduction abnormalities (RR 0.83,Cl 0.64-1.07),annular rupture (RR 0.73, Cl 0.27-1.99) and fluoroscopy time (DM 1.77, Cl – 0.06-3.61).
Our meta- analysis suggests that the use of LA in patients undergoing TAVR is associated with decreased mortality, shorter hospital stay, reduced vascular complications and procedural time. Further large randomized trials are needed to confirm our findings.
STRUCTURAL: Valvular Disease: Aortic