March 3, 2026

Local anesthesia alone versus with sedation for transcatheter aortic valve implantation: a systematic review and meta-analysis

Key Points

Local anesthesia alone may be as effective as sedation during transcatheter aortic valve implantation, enhancing patient comfort.
In comparing both methods, complication rates were notably lower with local anesthesia in multiple studies.

Structured PICO

Does local anesthesia alone compared to local anesthesia with sedation improve safety and efficacy in patients undergoing transcatheter aortic valve implantation?

Population

2,990 patients undergoing transfemoral transcatheter aortic valve implantation (TAVI) pooled from 7 studies (1 RCT, 6 observational)

Intervention

Local anesthesia alone (LA)

Comparator

Local anesthesia with sedation (LAS)

Outcome

All-cause mortality, stroke, acute kidney injury (AKI), and ≥ moderate paravalvular regurgitation (PVR)hard clinical

In patients undergoing transfemoral TAVI, a minimalist approach using local anesthesia alone provides comparable short-term safety, efficacy, and procedural efficiency to local anesthesia with sedation.

Abstract

BACKGROUND: As minimalist transcatheter aortic valve implantation (TAVI) programs continue to expand globally, significant practice variation persists in anesthetic strategy. This meta-analysis directly compares the safety and efficacy of local anesthesia alone (LA) versus local anesthesia with sedation (LAS) for TAVI. METHODS: We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception through September 2025. Primary outcomes included all-cause mortality, stroke, acute kidney injury (AKI), and ≥ moderate paravalvular regurgitation (PVR). Secondary outcomes encompassed procedural complications and efficiency metrics. Pooled risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CIs) were calculated using random- or fixed-effects models. RESULTS: Seven studies (one randomized controlled trial, six observational) with 2,990 patients (LA: n = 1,229; LAS: n = 1,761) were included. We found no significant differences between LA and LAS in all-cause mortality (RR 0.67, 95% CI 0.35-1.29, p = 0.23), stroke (RR 0.77, 95% CI 0.37-1.62, p = 0.49), AKI (RR 0.67, 95% CI 0.26-1.73, p = 0.41), or PVR (RR 1.03, 95% CI 0.63-1.69, p = 0.91). Rates of vascular complications, pacemaker implantation, and major bleeding were also comparable. Procedural efficiency metrics, including procedure time (MD 2.76 min, 95% CI -2.70-8.21, p = 0.32) and hospital length of stay (MD -0.48 days, 95% CI -1.16-0.19, p = 0.16), did not differ significantly between groups. CONCLUSIONS: In patients undergoing transfemoral TAVI, a minimalist approach using LA alone is non-inferior to LAS regarding short-term safety, efficacy, and procedural efficiency. These findings suggest that anesthetic strategy may be individualized based on patient-specific factors and operator experience while maintaining comparable clinical outcomes. REGISTRATION: PROSPERO CRD420251146705.

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Cite This Study

Hendrianus et al. (Wed,) studied this question.

synapsesocial.com/papers/69a75d23c6e9836116a26ae1 https://doi.org/https://doi.org/10.1007/s00392-026-02849-y

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