What question did this study set out to answer?

To compare the safety and clinical outcomes of locoregional anesthesia with or without conscious sedation versus general anesthesia for transcatheter aortic valve implantation.

April 4, 2016Current Pharmaceutical Design

General or Local Anesthesia for TAVI? A Systematic Review of the Literature and Meta-Analysis

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Why the study?

Does locoregional anesthesia compared to general anesthesia improve outcomes in patients undergoing TAVI?

Key Points

To compare the safety and clinical outcomes of locoregional anesthesia with or without conscious sedation versus general anesthesia for transcatheter aortic valve implantation.
Searched PUBMED, MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials for articles published between January 1, 2002, and February 15, 2015.
Identified and analyzed 10 non-randomized studies comprising 5,919 patients undergoing transcatheter aortic valve implantation.
Thirty-day mortality did not differ significantly between locoregional anesthesia and general anesthesia (RR 0.91, 95% CI: 0.53 to 1.56, p=0.72).
Locoregional anesthesia significantly reduced total procedure time and hospital length of stay compared to general anesthesia.
Locoregional anesthesia was associated with a higher risk of permanent pacemaker implantation (RR 1.23, p=0.02) and paravalvular leakage (RR 1.31, p=0.006).

Structured PICO

Does locoregional anesthesia compared to general anesthesia improve outcomes in patients undergoing TAVI?

Population

5,919 patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) across 10 non-randomized studies

Intervention

Locoregional anesthesia (LRA) with or without conscious sedation

Comparator

General anesthesia (GA)

Outcome

30-days mortality, hospital length of stay, procedure time, use of adrenergic support, stroke rate, incidence of myocardial infarction, incidence of acute kidney injury, rate of procedural successhard clinical

Locoregional anesthesia for TAVI is associated with shorter procedure times and hospital stays compared to general anesthesia, without affecting 30-day mortality, though it may increase the risk of permanent pacemaker implantation and paravalvular leakage.

Limitations

None of the included studies was randomized resulting in a considerable risk of bias

Discussion

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Implication

No 30-day mortality difference with LRA versus GA; leaves open whether procedural benefits outweigh higher PPM and leakage risks in RCTs.

Cite This Study

Maas et al. (2016) studied this question.

synapsesocial.com/papers/6a8d003358db4b48d89683bb https://doi.org/10.2174/1381612822666151208121825

Topics

Transcatheter aortic valve replacement TAVR in low-risk patients

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General or Local Anesthesia for TAVI? A Systematic Review of the Literature and Meta-Analysis

Key Points

Structured PICO

Limitations

Discussion

Implication

Cite This Study

Topics

General or Local Anesthesia for TAVI? A Systematic Review of the Literature and Meta-Analysis

Key Points

Structured PICO

Limitations

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider