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Meta-Analysis
. 2014 Mar 10:12:41.
doi: 10.1186/1741-7015-12-41.

Local versus general anesthesia for transcatheter aortic valve implantation (TAVR)--systematic review and meta-analysis

Georg M Fröhlich, Alexandra J Lansky, John Webb, Marco Roffi, Stefan Toggweiler, Markus Reinthaler, Duolao Wang, Nevil Hutchinson, Olaf Wendler, David Hildick-Smith, Pascal Meier  1
Affiliations
Meta-Analysis

Local versus general anesthesia for transcatheter aortic valve implantation (TAVR)--systematic review and meta-analysis

Georg M Fröhlich et al. BMC Med. .

Abstract

Background: The hypothesis of this study was that local anesthesia with monitored anesthesia care (MAC) is not harmful in comparison to general anesthesia (GA) for patients undergoing Transcatheter Aortic Valve Implantation (TAVR).TAVR is a rapidly spreading treatment option for severe aortic valve stenosis. Traditionally, in most centers, this procedure is done under GA, but more recently procedures with MAC have been reported.

Methods: This is a systematic review and meta-analysis comparing MAC versus GA in patients undergoing transfemoral TAVR. Trials were identified through a literature search covering publications from 1 January 2005 through 31 January 2013. The main outcomes of interest of this literature meta-analysis were 30-day overall mortality, cardiac-/procedure-related mortality, stroke, myocardial infarction, sepsis, acute kidney injury, procedure time and duration of hospital stay. A random effects model was used to calculate the pooled relative risks (RR) with 95% confidence intervals.

Results: Seven observational studies and a total of 1,542 patients were included in this analysis. None of the studies were randomized. Compared to GA, MAC was associated with a shorter hospital stay (-3.0 days (-5.0 to -1.0); P = 0.004) and a shorter procedure time (MD -36.3 minutes (-58.0 to -15.0 minutes); P <0.001). Overall 30-day mortality was not significantly different between MAC and GA (RR 0.77 (0.38 to 1.56); P = 0.460), also cardiac- and procedure-related mortality was similar between both groups (RR 0.90 (0.34 to 2.39); P = 0.830).

Conclusion: These data did not show a significant difference in short-term outcomes for MAC or GA in TAVR. MAC may be associated with reduced procedural time and shorter hospital stay. Now randomized trials are needed for further evaluation of MAC in the setting of TAVR.

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Figures

Figure 1
Figure 1
Flow chart of study selection process.
Figure 2
Figure 2
Forest plot of risk ratios for 30-day mortality. Markers represent point estimates of risk ratios, marker size represents study weight in random-effects meta-analysis. Horizontal bars indicate 95% confidence intervals. CI, confidence interval; RR, risk ratio.
Figure 3
Figure 3
Forest plot for conversion rate from MAC to GA. CI, confidence interval.
Figure 4
Figure 4
Forest plot for procedural time (minutes). CI, confidence interval.
Figure 5
Figure 5
Forest plot of risk ratios (RR) for stroke. CI, confidence interval; RR, risk ratio.
Figure 6
Figure 6
Forest plot for hospital stay (days). CI, confidence interval.
See this image and copyright information in PMC

References

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