Abstract 15166: Comparison of General versus Local Anesthesia in Patients Undergoing Transcatheter Aortic Valve Replacement (TAVR): A Meta-Analysis
Background: Transcatheter Aortic Valve Replacement (TAVR) is typically performed under general anesthesia with endotracheal intubation (GA). There is growing data in the literature however, that this procedure can be safely performed under local anesthesia (LA).
Hypothesis: To gain a better understanding of the efficacy and safety of GA as compared to LA in patients undergoing TAVR by conducting an updated meta-analysis.
Methods: We performed a comprehensive search of EMBASE, PUBMED, and Web of Science databases. Odds ratios (OR), difference of the mean (DM) and 95% confidence intervals (CI) were computed using the Mantel-Haenszel method. Fixed-effect model was used; if heterogeneity (I2)>40, effects were obtained using a random model. Sensitivity and cumulative analysis was performed for each outcome.
Results: A total of 18 studies and 19 255 patients were included in meta-analysis. The use of GA for TAVR was associated with an increased overall 30- day mortality (RR 1.35, Cl 1.07-1.70), length of stay (DM 2.33, CI 1.28-3.38), ICU stay (DM 8.98, CI 1.47-16.50), procedural time (DM 24.46, CI 16.52-32.41), use of vasopressors/inotropes (RR 1.95, CI 1.58-2.40), vascular complications (RR 1.41, CI 1.05-1.89) and post procedural intubation (RR 32.71, CI 18.18-58.88). TAVR with GA showed a lower incidence of paravalvular leak (RR 0.8, CI 0.66-0.80). No difference was observed between GA and LA for stroke (RR 1.15, Cl 0.91-1.45), cardiovascular mortality (RR 1.32, Cl 0.83-2.10), permanent pacemaker implantation (RR 1.32, Cl 0.83-2.10),vascular complications (RR 1.11, Cl 0.84-1.46),major bleeding (RR 1.09, Cl 0.70-1.68), acute kidney injury (RR1.07, CL 0.69-1.65), myocardial infarction (RR 0.72, Cl 0.39-1.33), procedural success (RR 1.01, CL 0.96-1.06),conduction abnormalities (RR 0.83,Cl 0.64-1.07),annular rupture (RR 0.73, Cl 0.27-1.99) and fluoroscopy time (DM 1.77, Cl – 0.06-3.61).
Conclusion: Our meta- analysis suggests that the use of LA in patients undergoing TAVR is associated with decreased mortality, shorter hospital stay, reduced vascular complications and procedural time. Further large randomized trials are needed to confirm our findings.
Author Disclosures: P. Villablanca: None. K. Nikolic: None. D. Vucicevic: None. Y. Maldonato: None. J. Augoustides: None. H. Ramakrishna: None.
- © 2016 by American Heart Association, Inc.