Meta-Analysis Evaluates Local Anesthesia for TAVR Procedures
August 7, 2017—Pedro A. Villablanca, MD, et al published findings from a meta-analysis that compared local versus general anesthesia in patients undergoing transcatheter aortic valve replacement (TAVR). The study is available online ahead of print in Catheterization and Cardiovascular Interventions.
According to the investigators, there are increasing data supporting the safety of local anesthesia/conscious sedation for TAVR, which is typically performed under general anesthesia. This meta-analysis evaluated the safety and efficacy of the two approaches in patients with severe aortic stenosis undergoing TAVR.
As summarized in Catheterization and Cardiovascular Interventions, the investigators conducted a comprehensive search of EMBASE, PubMed, and Web of Science; 26 studies and 10,572 patients were included in the meta-analysis. Effect sizes were summarized using risk ratios (RRs), difference of the mean (DM), and 95% confidence intervals (CI) for dichotomous and continuous variables, respectively.
The investigators found that the use of local anesthesia for TAVR was associated with lower overall 30-day mortality (RR, 0.73; 95% CI, 0.57–0.93; P = .01), use of inotropic/vasopressor drugs (RR, 0.45; 95% CI, 0.28–0.72; P < .001), hospital length of stay (DM, −2.09; 95% CI, −3.02 to −1.16; P < .001), intensive care unit length of stay (DM, −0.18; 95% CI, −0.31 to −0.04; P = .01), procedure time (DM, −25.02; 95% CI, −32.7 to −17.35; P < .001), and fluoroscopy time (DM, −1.63; 95% CI, −3.02 to −0.24; P = .02).
No differences were observed between local and general anesthesia 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.
The meta-analysis suggests that use of local anesthesia for TAVR is associated with a lower 30-day mortality, shorter procedure time, fluoroscopy time, intensive care unit length of stay, hospital length of stay, and reduced need for inotropic support, concluded the investigators in Catheterization and Cardiovascular Interventions.