Key result
Local anesthesia for TAVI resulted in shorter procedure duration and reduced vasoactive drug use compared to general anesthesia, with no significant difference in mortality.
Why the study?
The study aimed to compare the potential effects of local anesthesia and general anesthesia for transcatheter aortic valve implantation.
Does local anesthesia improve clinical outcomes and procedural metrics compared to general anesthesia in patients with severe aortic stenosis undergoing TAVI?
Meta-Analysis (n=20,938)
Does local anesthesia improve clinical outcomes and procedural metrics compared to general anesthesia in patients with severe aortic stenosis undergoing TAVI?
Local anesthesia is a safe and feasible alternative to general anesthesia for TAVI, offering shorter procedure times and reduced need for vasoactive drugs.
Answers are grounded in this paper and cite their sources.
No significant mortality difference between local and general anesthesia; leaves open optimal anesthesia choice in large cohorts.
BACKGROUND: This meta-analysis aimed to compare the potential effects of local anesthesia (LA) and general anesthesia (GA) for transcatheter aortic valve implantation (TAVI). MEASUREMENTS: All relevant studies were searched from Pubmed, EMbase, Web of Science, and the Cochrane Library (January 1, 2016, to June 1, 2021). The main outcomes of this literature meta-analysis were 30-day mortality, procedural time, new pacemaker implantation, total stay in the hospital, use of the vasoactive drug, and intra-and postoperative complications and emergencies, including conversion to open, myocardial infarction, pulmonary complication, vascular complication, renal injury/failure, stroke, transesophageal echocardiography, life-threatening/major bleeding, cardiac tamponade, and emergency PCI. Pooled risk ratio (RR) and mean difference (MD) together with a 95% confidence interval (CI) were calculated. RESULTS: A total of 17 studies, including 20938 patients, in the final analysis, fulfilled the inclusion criteria. Intra-and postoperative complications (myocardial infarction, vascular complication, renal injury/failure, stroke, and cardiac tamponade) undergoing TAVI in severe AS patients under GA do not offer a significant difference compared with LA. No differences were observed between LA and GA for new pacemaker implantation, total stay in the hospital, transesophageal echocardiography, and emergency PCI. LA has lower mortality compared with GA (RR 0.69, P = 0.600), pulmonary complications (RR 0.54, P = 0.278), life-threatening/major bleeding (RR 0.85, P = 0.855), and lower times of conversion to open (RR 0.22, P = 0.746). LA has many advantages, including a shorter procedure duration (MD=-0.38, P = 0.000) and reduction of the use of the vasoactive drug (RR 0.57, P = 0.000). CONCLUSIONS: For TAVI, both LA with or without sedation and GA are feasible and safe. LA appears a feasible alternative to GA for AS patients undergoing TAVI.
No takes yet. Share an insight, caveat, or question.
Gao et al. (2022) conducted a meta-analysis in Severe aortic stenosis undergoing TAVI (n=20,938). Local anesthesia vs. General anesthesia was evaluated on 30-day mortality (RR 0.69, p=0.600). Local anesthesia for TAVI resulted in shorter procedure duration and reduced vasoactive drug use compared to general anesthesia, with no significant difference in mortality.
Synapse has enriched 10 related papers. Consider them for comparative context: