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Open Access Research article

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

Georg M Fröhlich1, Alexandra J Lansky2, John Webb3, Marco Roffi4, Stefan Toggweiler5, Markus Reinthaler1, Duolao Wang6, Nevil Hutchinson7, Olaf Wendler8, David Hildick-Smith9 and Pascal Meier12*

Author Affiliations

1 The Heart Hospital, University College London Hospitals, London, UK

2 Division of Cardiology, Yale Medical School, New Haven, CT, USA

3 Department of Cardiology, St. Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada

4 Department of Cardiology, University Hospital Geneva HUGE, Geneva, Switzerland

5 Department of Cardiology, Kantonsspital Luzern, Lucerne, Switzerland

6 Department of Medical Statistics, London School of Hygiene and Tropical Medicine London, London, UK

7 Division of Anesthesiology, Brighton and Sussex University Hospital, Brighton, UK

8 Department of Cardiothoracic Surgery, King’s College Hospital, London, UK

9 Division of Cardiology, Brighton and Sussex University Hospital, Brighton, UK

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BMC Medicine 2014, 12:41  doi:10.1186/1741-7015-12-41

Published: 10 March 2014

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.

Keywords:
TAVR; Local anesthesia; General anesthesia; Aortic stenosis