Pedro A Villablanca1, Divyanshu Mohananey2, Katarina Nikolic3, Sripal Bangalore4, David P Slovut1,5, Verghese Mathew6, Vinod H Thourani7, Josep Rode's-Cabau8, Iván J Núñez-Gil9, Tina Shah10, Tanush Gupta1, David F Briceno1, Mario J Garcia1, Jacob T Gutsche11, John G Augoustides11, Harish Ramakrishna3. 1. Division of Cardiovascular Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York. 2. Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH. 3. Department of Anesthesiology, Mayo Clinic, Scottsdale, Arizona. 4. New York University School of Medicine, New York, New York. 5. Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York. 6. Division of Cardiology, Loyola University Stritch School of Medicine, Maywood, Illinois. 7. Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia. 8. Québec Heart and Lung Institute, Quebec City, Quebec, Canada. 9. Instituto Cardiovascular Hospital Clínico San Carlos, Madrid, Spain. 10. Department of Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York. 11. Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Abstract
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.
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.
Authors: Shara S Azad; Frederick C Cobey; Lori Lyn Price; Roman Schumann; Alexander D Shapeton Journal: J Cardiothorac Vasc Anesth Date: 2020-05-15 Impact factor: 2.628
Authors: Florence Leclercq; Pierre Alain Meunier; Thomas Gandet; Jean-Christophe Macia; Delphine Delseny; Philippe Gaudard; Marc Mourad; Laurent Schmutz; Pierre Robert; François Roubille; Guillaume Cayla; Mariama Akodad Journal: J Clin Med Date: 2022-05-16 Impact factor: 4.964
Authors: Dae Hyun Kim; Jonathan Afilalo; Sandra M Shi; Jeffrey J Popma; Kamal R Khabbaz; Roger J Laham; Francine Grodstein; Kimberly Guibone; Eliah Lux; Lewis A Lipsitz Journal: JAMA Intern Med Date: 2019-03-01 Impact factor: 21.873
Authors: Didrik Kjønås; Gry Dahle; Henrik Schirmer; Siri Malm; Jo Eidet; Lars Aaberge; Terje Steigen; Svend Aakhus; Rolf Busund; Assami Rösner Journal: Open Heart Date: 2019-04-23
Authors: Ines Sherifi; Alaa Mabrouk Salem Omar; Mithun Varghese; Menachem Weiner; Ani Anyanwu; Jason C Kovacic; Samin Sharma; Annapoorna Kini; Partho P Sengupta Journal: Echo Res Pract Date: 2018-05-09