ABSTRACT
Objectives
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.
Design
Random effects pairwise meta-analysis via the Mantel-Haenszel method.
Setting
Not applicable, this is a meta-analysis.
Participants
No individual patient data were used.
Intervention
Not applicable, this is a meta-analysis.
Measurement/Results
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).
Conclusions
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.
Key Words
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Article info
Publication history
Publication stage
In Press Accepted ManuscriptIdentification
Copyright
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