Original Article|Articles in Press

General anesthesia versus local anesthesia in patients undergoing transcatheter aortic valve replacement: an updated meta-analysis & systematic review

Published:March 13, 2023DOI:



      For patients with aortic stenosis, transcatheter aortic valve replacement(TAVR) offers a less invasive treatment modality compared to conventional surgical valve replacement. While the operation is traditionally performed under general anesthesia(GA), recent studies have described success with TAVR using local anesthesia / conscious sedation(LA). We performed a pairwise meta-analysis to compare the clinical outcomes of TAVR based on operative anesthesia management.


      Random effects pairwise meta-analysis via the Mantel-Haenszel method.


      Not applicable, this is a meta-analysis.


      No individual patient data were used.


      Not applicable, this is a meta-analysis.


      We comprehensively searched the PubMed, Embase and Cochrane databases to identify studies comparing TAVR performed using LA or GA. Outcomes were pooled as risk ratios (RR) or standard mean differences (SMD) and their 95% confidence intervals (95% CI). Our pooled analysis included 14,388 patients from 40 studies(7,754 LA, 6,634 GA). Compared to GA TAVR, LA TAVR was associated with significantly lower rates of 30-day mortality (RR 0.69; p<0.01) and stroke (RR 0.78; p=0.02). Additionally, LA TAVR patients had lower rates of 30-day major/life-threatening bleeding (RR 0.64; p=0.01), 30-day major vascular complications (RR 0.76; p=0.02) and long-term mortality (RR 0.75; p=0.009). No significant difference was seen between the two groups for 30-day paravalvular leak (RR 0.88, p=0.12).


      TAVR performed using LA is associated with lower rates of adverse clinical outcomes including 30-day mortality and stroke. No difference was seen between the two groups for 30-day paravalvular leak. These results support the use of minimally invasive forms of TAVR without GA.

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