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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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| Published in: | BMC medicine 2014-03, Vol.12 (1), p.41-41, Article 41 |
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| creator | 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 |
| description | 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 |
| doi_str_mv | 10.1186/1741-7015-12-41 |
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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 <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).
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.</description><identifier>ISSN: 1741-7015</identifier><identifier>EISSN: 1741-7015</identifier><identifier>DOI: 10.1186/1741-7015-12-41</identifier><identifier>PMID: 24612945</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>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</subject><ispartof>BMC medicine, 2014-03, Vol.12 (1), p.41-41, Article 41</ispartof><rights>COPYRIGHT 2014 BioMed Central Ltd.</rights><rights>2014 Fröhlich et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.</rights><rights>Copyright © 2014 Fröhlich et al.; licensee BioMed Central Ltd. 2014 Fröhlich et al.; licensee BioMed Central Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c585t-72f046166b3b9b6326155bf471556cc5274c047bbebf2c5fd5b5d04b41c3e66f3</citedby><cites>FETCH-LOGICAL-c585t-72f046166b3b9b6326155bf471556cc5274c047bbebf2c5fd5b5d04b41c3e66f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4022332/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/1516608682?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,25753,27924,27925,37012,37013,44590,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24612945$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fröhlich, Georg M</creatorcontrib><creatorcontrib>Lansky, Alexandra J</creatorcontrib><creatorcontrib>Webb, John</creatorcontrib><creatorcontrib>Roffi, Marco</creatorcontrib><creatorcontrib>Toggweiler, Stefan</creatorcontrib><creatorcontrib>Reinthaler, Markus</creatorcontrib><creatorcontrib>Wang, Duolao</creatorcontrib><creatorcontrib>Hutchinson, Nevil</creatorcontrib><creatorcontrib>Wendler, Olaf</creatorcontrib><creatorcontrib>Hildick-Smith, David</creatorcontrib><creatorcontrib>Meier, Pascal</creatorcontrib><title>Local versus general anesthesia for transcatheter aortic valve implantation (TAVR)--systematic review and meta-analysis</title><title>BMC medicine</title><addtitle>BMC Med</addtitle><description>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 <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).
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.</description><subject>Aged</subject><subject>Analysis</subject><subject>Anesthesia</subject><subject>Anesthesia, General</subject><subject>Anesthesia, Local</subject><subject>Aortic valve stenosis</subject><subject>Aortic Valve Stenosis - surgery</subject><subject>Care and treatment</subject><subject>Data analysis</subject><subject>Drug therapy</subject><subject>Female</subject><subject>Health aspects</subject><subject>Heart attacks</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Length of Stay</subject><subject>Medical research</subject><subject>Medicine, Experimental</subject><subject>Meta-analysis</subject><subject>Mortality</subject><subject>Patient outcomes</subject><subject>Risk</subject><subject>Risk factors</subject><subject>Severity of Illness Index</subject><subject>Stroke - complications</subject><subject>Studies</subject><subject>Surgery</subject><subject>Syntax</subject><subject>Transcatheter Aortic Valve Replacement - 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surgery</topic><topic>Care and treatment</topic><topic>Data analysis</topic><topic>Drug therapy</topic><topic>Female</topic><topic>Health aspects</topic><topic>Heart attacks</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Length of Stay</topic><topic>Medical research</topic><topic>Medicine, Experimental</topic><topic>Meta-analysis</topic><topic>Mortality</topic><topic>Patient outcomes</topic><topic>Risk</topic><topic>Risk factors</topic><topic>Severity of Illness Index</topic><topic>Stroke - complications</topic><topic>Studies</topic><topic>Surgery</topic><topic>Syntax</topic><topic>Transcatheter Aortic Valve Replacement - methods</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fröhlich, Georg M</creatorcontrib><creatorcontrib>Lansky, Alexandra J</creatorcontrib><creatorcontrib>Webb, John</creatorcontrib><creatorcontrib>Roffi, Marco</creatorcontrib><creatorcontrib>Toggweiler, Stefan</creatorcontrib><creatorcontrib>Reinthaler, Markus</creatorcontrib><creatorcontrib>Wang, Duolao</creatorcontrib><creatorcontrib>Hutchinson, Nevil</creatorcontrib><creatorcontrib>Wendler, Olaf</creatorcontrib><creatorcontrib>Hildick-Smith, David</creatorcontrib><creatorcontrib>Meier, Pascal</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMC medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fröhlich, Georg M</au><au>Lansky, Alexandra J</au><au>Webb, John</au><au>Roffi, Marco</au><au>Toggweiler, Stefan</au><au>Reinthaler, Markus</au><au>Wang, Duolao</au><au>Hutchinson, Nevil</au><au>Wendler, Olaf</au><au>Hildick-Smith, David</au><au>Meier, Pascal</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Local versus general anesthesia for transcatheter aortic valve implantation (TAVR)--systematic review and meta-analysis</atitle><jtitle>BMC medicine</jtitle><addtitle>BMC Med</addtitle><date>2014-03-10</date><risdate>2014</risdate><volume>12</volume><issue>1</issue><spage>41</spage><epage>41</epage><pages>41-41</pages><artnum>41</artnum><issn>1741-7015</issn><eissn>1741-7015</eissn><abstract>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 <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).
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.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>24612945</pmid><doi>10.1186/1741-7015-12-41</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| 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 |
| title | Local versus general anesthesia for transcatheter aortic valve implantation (TAVR)--systematic review and meta-analysis |
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