Key result
Conscious or deep sedation showed no significant difference in procedural success (OR 0.75; 95% CI 0.30-1.88; P=0.538) or in-hospital mortality compared to general anaesthesia for TOE-guided PMVR.
Why the study?
TOE-guided PMVR is typically performed under general anaesthesia, but increasing evidence supports the efficacy and safety of conscious or deep sedation.
Does conscious or deep sedation improve procedural success or mortality compared to general anaesthesia in patients undergoing TOE-guided PMVR?
Meta-Analysis
Does conscious or deep sedation improve procedural success or mortality compared to general anaesthesia in patients undergoing TOE-guided PMVR?
Odds Ratio: 0.75 (95% CI 0.3–1.88)
p-value: p=0.538
Supports conscious or deep sedation as alternative to general anaesthesia in TOE-guided PMVR; confirms comparable success and mortality with shorter ICU stay.
AIMS: Transoesophageal echocardiography-guided percutaneous transcatheter mitral valve repair (TOE-guided PMVR) using edge-to-edge leaflet plication is typically performed under general anaesthesia (GA). Increasing evidence supports the efficacy and safety of PMVR performed under conscious sedation (CS) or deep sedation (DS). We performed a meta-analysis comparing safety and efficacy of CS/DS vs. GA in PMVR. METHODS AND RESULTS: A comprehensive search was performed using PubMed, CINAHL, Ovid MEDLINE, Embase, and the Cochrane Library. Study characteristics, participant demographics, and procedural outcomes with both types of anaesthesia were analysed. Out of 73 articles, five met inclusion criteria. Overall, there was no significant difference in the primary outcome of procedural success rate [odds ratio (OR) 0.75; 95% confidence interval (CI) 0.30-1.88, I2= 0.0%, P = 0.538] or post-procedure in-hospital mortality (OR 1.02; 95% CI 0.38-2.71, I2= 0.0%, P = 0.970) in the patients undergoing PMVR under CS/DS vs. GA. The secondary endpoint of intensive care unit (ICU) length of stay (LOS) was significantly shorter in patients under CS/DS vs. GA (standardized mean difference, SMD = -0.97; 95% CI -1.75 to -0.20; P = 0.014), but the hospital LOS (SMD = 0.36; 95% CI -0.77 to 0.04, P = 0.078) did not show a statistically significant difference between the groups, although it was shorter in the CS/DS group. No difference was observed between CS/DS and GA in fluoroscopy time, procedure time, or complications, including pneumonia, stroke/transient ischaemic attack, and major bleeding. CONCLUSION: CS or DS has lower ICU LOS, but comparable procedural success rate and in-hospital mortality, making it a potential alternative to GA for TOE-guided PMVR.
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Banga et al. (2020) conducted a meta-analysis in Transoesophageal echocardiography-guided percutaneous transcatheter mitral valve repair (TOE-guided PMVR). Conscious sedation (CS) or deep sedation (DS) vs. General anaesthesia (GA) was evaluated on Procedural success rate (OR 0.75, 95% CI 0.30-1.88, p=0.538). Conscious or deep sedation showed no significant difference in procedural success (OR 0.75; 95% CI 0.30-1.88; P=0.538) or in-hospital mortality compared to general anaesthesia for TOE-guided PMVR.
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