Local anesthesia for TAVR was associated with lower overall 30-day mortality compared to general anesthesia (RR 0.73; 95% CI 0.57-0.93; P=0.01).
Meta-Analysis (n=10,572)
Does local anesthesia/conscious sedation reduce 30-day mortality and improve procedural metrics compared to general anesthesia in patients undergoing TAVR?
Local anesthesia/conscious sedation for TAVR is associated with lower 30-day mortality, shorter hospital stays, and reduced need for inotropic support compared to general anesthesia, without increasing procedural complications.
Relative Risk: 0.73 (95% CI 0.57–0.93)
p-value: p=0.01
BACKGROUND: 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. METHODS AND RESULTS: 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; P = 0.01), use of inotropic/vasopressor drugs (RR, 0.45; 95% CI, 0.28-0.72; P < 0.001), hospital length of stay (LOS) (DM, -2.09; 95% CI, -3.02 to -1.16; P < 0.001), intensive care unit LOS (DM, -0.18; 95% CI, -0.31 to -0.04; P = 0.01), procedure time (DM, -25.02; 95% CI, -32.70 to -17.35; P < 0.001); and fluoroscopy time (DM, -1.63; 95% CI, -3.02 to -0.24; P = 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. CONCLUSION: 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.
Villablanca et al. (Mon,) conducted a meta-analysis in Severe aortic stenosis undergoing TAVR (n=10,572). Local anesthesia/conscious sedation (LA) vs. General anesthesia (GA) was evaluated on Overall 30-day mortality (RR 0.73, 95% CI 0.57-0.93, p=0.01). Local anesthesia for TAVR was associated with lower overall 30-day mortality compared to general anesthesia (RR 0.73; 95% CI 0.57-0.93; P=0.01).