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

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. Tr...

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Bibliographic Details
Published in:BMC medicine 2014-03, Vol.12 (1), p.41-41, Article 41
Main Authors: Fröhlich, Georg M, Lansky, Alexandra J, Webb, John, Roffi, Marco, Toggweiler, Stefan, Reinthaler, Markus, Wang, Duolao, Hutchinson, Nevil, Wendler, Olaf, Hildick-Smith, David, Meier, Pascal
Format: Article
Language:English
Subjects:
Aged
Analysis
Anesthesia
Anesthesia, General
Anesthesia, Local
Aortic valve stenosis
Aortic Valve Stenosis - surgery
Care and treatment
Data analysis
Drug therapy
Female
Health aspects
Heart attacks
Hospitals
Humans
Length of Stay
Medical research
Medicine, Experimental
Meta-analysis
Mortality
Patient outcomes
Risk
Risk factors
Severity of Illness Index
Stroke - complications
Studies
Surgery
Syntax
Transcatheter Aortic Valve Replacement - methods
Treatment Outcome
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Summary: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. 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. 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
ISSN:1741-7015
1741-7015
DOI:10.1186/1741-7015-12-41