Comparison of local versus general anesthesia in patients undergoing transcatheter aortic valve replacement: A meta‐analysis
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- Pedro A. Villablanca
- Division of Cardiovascular Diseases Montefiore Medical Center/Albert Einstein College of Medicine New York New York
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- Divyanshu Mohananey
- Department of Hospital Medicine Cleveland Clinic Cleveland OH
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- Katarina Nikolic
- Department of Anesthesiology Mayo Clinic Scottsdale Arizona
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- Sripal Bangalore
- New York University School of Medicine New York New York
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- David P. Slovut
- Division of Cardiovascular Diseases Montefiore Medical Center/Albert Einstein College of Medicine New York New York
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- Verghese Mathew
- Division of Cardiology Loyola University Stritch School of Medicine Maywood Illinois
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- Vinod H. Thourani
- Division of Cardiothoracic Surgery Emory University School of Medicine Atlanta Georgia
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- Josep Rode's‐Cabau
- Québec Heart and Lung Institute Quebec City Quebec Canada
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- Iván J. Núñez‐Gil
- Instituto Cardiovascular Hospital Clínico San Carlos Madrid Spain
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- Tina Shah
- Department of Internal Medicine Montefiore Medical Center/Albert Einstein College of Medicine New York New York
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- Tanush Gupta
- Division of Cardiovascular Diseases Montefiore Medical Center/Albert Einstein College of Medicine New York New York
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- David F. Briceno
- Division of Cardiovascular Diseases Montefiore Medical Center/Albert Einstein College of Medicine New York New York
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- Mario J. Garcia
- Division of Cardiovascular Diseases Montefiore Medical Center/Albert Einstein College of Medicine New York New York
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- Jacob T. Gutsche
- Department of Anesthesiology and Critical Care Perelman School of Medicine, University of Pennsylvania Philadelphia Pennsylvania
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- John G. Augoustides
- Department of Anesthesiology and Critical Care Perelman School of Medicine, University of Pennsylvania Philadelphia Pennsylvania
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- Harish Ramakrishna
- Department of Anesthesiology Mayo Clinic Scottsdale Arizona
Abstract
<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Transcatheter aortic valve replacement (TAVR) is typically performed under general anesthesia (GA). However, there is increasing data supporting the safety of performing TAVR under local anesthesia/conscious sedation (LA). We performed a meta‐analysis to gain better understanding of the safety and efficacy of LA versus GA in patients with severe aortic stenosis undergoing TAVR.</jats:p></jats:sec><jats:sec><jats:title>Methods and Results</jats:title><jats:p>We comprehensively searched EMBASE, PubMed, and Web of Science. Effect sizes were summarized using risk ratios (RRs) difference of the mean (DM), and 95% CIs (confidence intervals) for dichotomous and continuous variables respectively. Twenty‐six studies and 10,572 patients were included in the meta‐analysis. The use of LA for TAVR was associated with lower overall 30‐day mortality (RR, 0.73; 95% CI, 0.57–0.93; <jats:italic>P</jats:italic> = 0.01), use of inotropic/vasopressor drugs (RR, 0.45; 95% CI, 0.28–0.72; <jats:italic>P</jats:italic> < 0.001), hospital length of stay (LOS) (DM, −2.09; 95% CI, −3.02 to −1.16; <jats:italic>P</jats:italic> < 0.001), intensive care unit LOS (DM, −0.18; 95% CI, −0.31 to −0.04; <jats:italic>P</jats:italic> = 0.01), procedure time (DM, −25.02; 95% CI, −32.70 to −17.35; <jats:italic>P</jats:italic> < 0.001); and fluoroscopy time (DM, −1.63; 95% CI, −3.02 to −0.24; <jats:italic>P</jats:italic> = 0.02). No differences were observed between LA and GA for stroke, cardiovascular mortality, myocardial infarction, permanent pacemaker implantation, acute kidney injury, paravalvular leak, vascular complications, major bleeding, procedural success, conduction abnormalities, and annular rupture.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Our meta‐analysis suggests that use of LA for TAVR is associated with a lower 30‐day mortality, shorter procedure time, fluoroscopy time, ICU LOS, hospital length of stay, and reduced need for inotropic support.</jats:p></jats:sec>
Journal
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- Catheterization and Cardiovascular Interventions
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Catheterization and Cardiovascular Interventions 91 (2), 330-342, 2017-07-24
Wiley
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Details 詳細情報について
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- CRID
- 1363670320034511744
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- ISSN
- 1522726X
- 15221946
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- Data Source
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- Crossref