Comparison of clinical outcomes with the utilization of monitored anesthesia care vs. general anesthesia in patients undergoing transcatheter aortic valve replacement

Kiramijyan, Sarkis; Ben‐Dor, Itsik; Koifman, Edward; Didier, Romain; Magalhães, Marco A.; Escárcega, Ricardo O.; Negi, Smita; Baker, Nevin C.; Gai, Junyi; Torguson, Rebecca; Okubagzi, Petros; Asch, Federico M.; Wang, Zuyue; Gaglia, Michael A.; Satler, Lowell F.; Pichard, Augusto D.; Waksman, Ron

doi:10.1016/j.carrev.2016.02.003

Cited by 40 publications

(30 citation statements)

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“…We reviewed 35 full-text articles and identified 20 articles for inclusion in our review (figure 1). [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] All the studies were observational studies except one RCT. 32 Table 1 shows the baseline clinical characteristics of the included studies.…”

Section: Study Selection and Eligibility Criteriamentioning

confidence: 99%

Is local anaesthesia a favourable approach for transcatheter aortic valve implantation? A systematic review and meta-analysis comparing local and general anaesthesia

et al. 2017

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ObjectivesWe conducted a systematic review and meta-analysis to identify the potential favourable effects of local anaesthesia plus sedation (LAS) compared with general anaesthesia (GA) in transcatheter aortic valve implantation (TAVI).MethodsElectronic databases (PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials) and the reference lists of eligible publications were screened for randomised controlled trials (RCTs) and observational studies published between 1 January 2006 and 26 June 2016 that compare LAS to GA in an adult study population undergoing TAVI. We conducted study quality assessments using the Cochrane risk of bias tool and structured the review according to PRISMA. A meta-analysis calculating the pooled risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) under the assumption of a random-effects model was performed. Statistical heterogeneity was evaluated using the I² statistic and Cochran’s Q-test.ResultsAfter database screening, one RCT and 19 observational studies were included in the review. We found no differences between LAS and GA in terms of 30-day mortality, in-hospital mortality and other endpoints that addressed safety and complication rates. LAS was associated with a shorter ICU and hospital stay and with lower rates of catecholamine administration and red blood cell transfusion. New pacemaker implantations occurred more frequently under LAS. The overall conversion rate from LAS to GA was 6.2%.ConclusionFor TAVI, both LAS and GA are feasible and safe. LAS may have some benefits such as increased haemodynamic stability and shorter hospital and ICU stays, but it does not impact 30-day mortality. Since there is a paucity of randomised trial data and the findings are mainly based on observational study data, this review should be considered as a hypothesis-generating article for subsequent RCTs that are required to confirm the potential favourable effects we detected for LAS.Registration numberCRD42016048398 (PROSPERO).

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Section: Study Selection and Eligibility Criteriamentioning

confidence: 99%

Is local anaesthesia a favourable approach for transcatheter aortic valve implantation? A systematic review and meta-analysis comparing local and general anaesthesia

et al. 2017

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“…After European and US centers, the safety and feasibility of TAVR with LA/CS compared to general anesthesia has been widely investigated in many clinical studies. 4,20,21 Although the strategy varies among studies, 21,22 the most common approach consists of infiltration of lidocaine at the access site, and administration of remifentanyl or fentanyl associated with propofol and/or midazolam. Transfemoral approach is the most commonly used and preferred access site.…”

Section: Local Anesthesia/conscious Sedationmentioning

confidence: 99%

“…21,26 LA/CS were associated with lower rates of systemic hypertension and subsequent intra and post-procedural inotropic support, and potentially lower pulmonary complications rate, like the incidence of respiratory failure and pneumonia associated with mechanical ventilation. 22,23 As a result, early recovery after the procedure can be achieved, leading to a shorter length of post-procedural ICU stay and LOS, 12,20,22,25,27 e.g. mean 1.5-2.1 days shorter in LOS under LA/CS than under general anesthesia.…”

Section: Local Anesthesia/conscious Sedationmentioning

confidence: 99%

“…5,25 However, emergent conversion from LA/CS to general anesthesia is not rare, showing a wide range of incidence rates between 2.9% and 12% in large clinical studies. 22 The predominant reasons for the conversion are patient uncooperativeness or discomfort, as well as procedural complications, such as vascular complications, hemodynamic compromise, and cardiac tamponade. This emphasizes the importance of preparedness for swift conversion to general anesthesia, with the capacity of the emergent management of catastrophic complications.…”

Section: Local Anesthesia/conscious Sedationmentioning

confidence: 99%

“…CS to general anesthesia was 5.9%, which was consistent with previous reports. 28 According to these prior reports, 12,20,22,25,27 transfemoral TAVR under LA/CS seems to be feasible and safe with the merit of shorter LOS. However, majority of these studies are observational, and randomized, controlled trials are scarce, 29 a potential caveat of which is patient selection bias, e.g.…”

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confidence: 98%

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Minimalist approach for transcatheter aortic valve replacement

Dallan¹,

Ichibori²,

Attizzani³

2019

J Transcat Intervent

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Transcatheter aortic valve replacement became a routine interventional procedure worldwide, together with improvements in valve technology and optimized implant techniques. The concept of minimalist approach became relevant, aiming at optimal technical implant, fewer perioperative comorbidities, and consequently faster recovery and less associated risks. Compared with surgical aortic valve replacement, reduction of hospital and intensive care unit stay and fewer rates of procedural complications offset the high costs of transcatheter aortic valve replacement valves. The principles of the minimalist approach consist on top performance by experienced structural interventionists, a complete transcatheter basis under local anesthesia and conscious sedation, together with bedside transthoracic echocardiography to access hemodynamic features. It is necessary to customize transcatheter aortic valve replacement optimal procedure by revising how to simplify each aspect of the patient's care process, without losing focus on safety and best outcomes based on individualized patient characteristics, center's expertise, and multidisciplinary care. This review aimed to summarize the current evidence for a minimalist approach to transfemoral transcatheter aortic valve replacement and provide information for its safe and successful implementation and customization.Keywords: Transcatheter aortic valve replacement; Aortic valve/surgery; Aortic valve stenosis; Heart valve prosthesis implantation/methods resumo -O implante transcateter de válvula aórtica tornou-se uma intervenção de rotina em todo o mundo, acompanhando as melhorias na tecnologia das válvulas e a otimização das técnicas de implante. O conceito de abordagem minimalista tornou-se relevante, visando obter um implante tecnicamente ideal, menos comorbidades perioperatórias e, consequentemente, recuperação mais rápida e com menos riscos associados. Em comparação à cirurgia de troca da válvula aórtica, a redução no tempo de hospitalização e na unidade de terapia intensiva, e a menor incidência de complicações do procedimento acabam por compensar os custos mais altos das válvulas para o implante transcateter de válvula aórtica. Os princípios da abordagem minimalista consistem em desempenho superior de intervencionistas estruturais experientes, uma base estrutural completa sob anestesia local e sedação consciente, juntamente da ecocardiografia transtorácica à beira do leito, para avaliar características hemodinâmicas. É necessário customizar um procedimento ideal do implante transcateter de válvula aórtica, procurando simplificar cada um dos aspectos da atenção ao paciente, sem perder o foco na segurança e na obtenção dos melhores desfechos, com base nas características individuais na experiência do centro e no atendimento multidisciplinar. Esta revisão teve como objetivo sintetizar as evidências atuais para uma abordagem minimalista do implante transcateter de válvula aórtica transfemoral, e fornecer informações para garantir a segurança e o sucesso da implementação e customi...

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Comparison of local versus general anesthesia in patients undergoing transcatheter aortic valve replacement: A meta‐analysis

Villablanca

Mohananey

Nikolić

et al. 2017

Cathet Cardio Intervent

103

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Comparison of clinical outcomes with the utilization of monitored anesthesia care vs. general anesthesia in patients undergoing transcatheter aortic valve replacement

Cited by 40 publications

References 28 publications

Is local anaesthesia a favourable approach for transcatheter aortic valve implantation? A systematic review and meta-analysis comparing local and general anaesthesia

Is local anaesthesia a favourable approach for transcatheter aortic valve implantation? A systematic review and meta-analysis comparing local and general anaesthesia

Minimalist approach for transcatheter aortic valve replacement

Comparison of local versus general anesthesia in patients undergoing transcatheter aortic valve replacement: A meta‐analysis

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