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

Villablanca, Pedro A.; Mohananey, Divyanshu; Nikolić, Katarina; Bangalore, Sripal; Slovut, David P.; Mathew, Verghese; Thourani, Vinod H.; Rodés‐Cabau, Josep; Núñez‐Gil, Iván J.; Shah, Tina; Gupta, Tanush; Briceño, David; García, Mario J.; Gutsche, Jacob T.; Augoustides, John; Ramakrishna, Harish

doi:10.1002/ccd.27207

Cited by 103 publications

(74 citation statements)

References 42 publications

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“…It is encouraging to observe that both vascular complications and bleeding events decreased over time. While this may reflect a lower risk population over the years, operator experience and technological advancements (specifically, smaller delivery systems) may also have a role to play . However, this trend was not significant in patients with PAD, and therefore, these patients remain at higher risk than their counterparts without PAD.…”

Section: Discussionmentioning

confidence: 95%

Association of peripheral artery disease with in‐hospital outcomes after endovascular transcatheter aortic valve replacement

Mohananey

Villablanca

Gupta

et al. 2019

Cathet Cardio Intervent

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Objectives The aim of this study was to determine the prevalence of peripheral artery disease (PAD) and its association with in‐hospital outcomes after endovascular transcatheter aortic valve replacement (EV‐TAVR). Background TAVR is an established treatment for patients at prohibitive, high, or intermediate surgical risk. PAD is a significant comorbidity in the determination of surgical risk. However, data on association of PAD with outcomes after EV‐TAVR are limited. Methods Patients in the National Inpatient Sample who underwent EV‐TAVR between January 1, 2012 and September 30, 2015 were evaluated. The primary outcome was in‐hospital mortality. Results A total of 51,685 patients underwent EV‐TAVR during the study period. Of these, 12,740 (24.6%) had a coexisting diagnosis of PAD. The adjusted odds for in‐hospital mortality [OR 1.08 (95% CI 0.83–1.41)], permanent pacemaker implantation [OR 0.98 (0.85–1.14)], conversion to open aortic valve replacement [OR 1.05 (0.49–2.26)], or acute myocardial infarction [OR 1.31(0.99–1.71)] were not different in patients with versus without PAD. However, patients with PAD had greater adjusted odds of vascular complications [OR 1.80 (1.50–2.16)], major bleeding [OR 1.20 (1.09–1.34)], acute kidney injury (AKI) [OR 1.19 (1.05–1.36)], cardiac complications [aOR 1.21 (1.01–1.44)], and stroke [OR 1.39(1.10–1.75)] compared with patients without PAD. Length of stay (LOS) was significantly longer for patients with PAD [7.23 (0.14) days vs. 7.11 (0.1) days, p < 0.001]. Conclusion Of patients undergoing EV‐TAVR, ~25% have coexisting PAD. PAD was not associated with increased risk of in‐hospital mortality but was associated with higher risk of vascular complications, major bleeding, AKI, stroke, cardiac complications, and longer LOS.

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Section: Discussionmentioning

confidence: 95%

Association of peripheral artery disease with in‐hospital outcomes after endovascular transcatheter aortic valve replacement

Mohananey

Villablanca

Gupta

et al. 2019

Cathet Cardio Intervent

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“…Another factor is that since our data includes the early experience of TAVR in the United States when general anesthesia was more frequently used compared to local anesthesia, it may have resulted in increased cost. In fact, Villablanca et al from their recent meta‐analysis showed that local anesthesia compared to general anesthesia reduced 30‐day mortality, use of inotropic/vasopressor drugs, hospital and intensive care unit stay lengths . Similarly, Babaliaros et al reported that minimalist TAVR (defined as TAVR performed under local anesthesia, minimal conscious sedation, fully percutaneous access site entry and closure, and transthoracic echocardiography) resulted in lower resource use and less cost ($45, 485 ± 14,397 vs. 55,377 ± 22,587) .…”

Section: Discussionmentioning

confidence: 99%

Hospital outcomes of transcatheter versus surgical aortic valve replacement in female in the United States

Ando

Akintoye

Telila

et al. 2017

Cathet Cardio Intervent

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“…There are limited data on sedation during PMC, especially concerning sedation's impact on hemodynamic parameters in the setting of severe rheumatic MS in developing countries [6]. The choice of anesthesia technique varies according to the experience of each service, and general anesthesia or sedation may be performed [7]. Sedation techniques have evolved over the past decades resulting in more effective and titratable strategies [8].…”

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confidence: 99%

The Importance of Conscious Sedation for Life-Saving Valve Procedures in Patients With Rheumatic Heart Disease From Low- to Middle-Income Countries

Alcici

Lodi-Junqueira

Sant’Anna

et al. 2019

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Background: Severe valve disease, which requires intervention, remains strongly associated with mortality in patients with rheumatic heart disease. Percutaneous mitral commissurotomy (PMC) is the procedure of choice for the treatment of patients with isolated or predominantly rheumatic mitral stenosis. This procedure has been performed under sedation to avoid the potential effects of general anesthesia on intracardiac pressure measurements. However, there are limited data on sedation during PMC, especially using easily available medications in low-and middle-income countries.Objectives: This study was designed to evaluate the efficacy and hemodynamic effects of conscious sedation during PMC in patients with significant mitral stenosis.Methods: This study prospectively enrolled 23 patients who underwent PMC with the Inoue balloon technique for hemodynamically significant mitral stenosis. For conscious sedation, midazolam 25 mg/kg and fentanyl 1 mg/kg were administered, and 5 min after the infusion, the level of sedation was evaluated by Ramsay sedation scale. A range of invasive hemodynamic measurements, including cardiac output and pulmonary artery pressures, were recorded before and immediately after sedation.Results: The mean age was 44.9 AE 10.8 years, and 19 patients (83%) were women. After sedation, the majority of patients were in categories 2 and 3 of the Ramsay sedation scale (cooperative, orientated, tranquil, and responding to commands). Oxygen saturation dropped from an average of 98.5% to 96.0% without supplementary oxygen. Left ventricular systolic pressure and central aortic pressures decreased after sedation. However, none of the other parameters changed significantly after sedation, including pulmonary artery pressures, pulmonary vascular resistance, and cardiac index.Conclusions: This simple model of conscious sedation was able to promote anxiolysis, analgesia, and comfort for the procedure without serious hemodynamic effects, which can be a reasonable choice in developing countries. pala, Uganda. Correspondence: M. C. P. Nunes (

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

Abstract: Our meta-analysis suggests that use of LA for TAVR is associated with a lower 30-day mortality, shorter procedure time, fluoroscopy time, ICU LOS, hospital length of stay, and reduced need for inotropic support.

Cited by 103 publications

References 42 publications

Association of peripheral artery disease with in‐hospital outcomes after endovascular transcatheter aortic valve replacement

Association of peripheral artery disease with in‐hospital outcomes after endovascular transcatheter aortic valve replacement

Hospital outcomes of transcatheter versus surgical aortic valve replacement in female in the United States

The Importance of Conscious Sedation for Life-Saving Valve Procedures in Patients With Rheumatic Heart Disease From Low- to Middle-Income Countries

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