Comparison of Sedation and General Anaesthesia for Transcatheter Aortic Valve Implantation on Cerebral Oxygen Saturation and Neurocognitive Outcome

Mayr, Norbert; Hapfelmeier, Alexander; Martin, Klaus; Kurz, Alexander; Starre, Pieter van der; Babik, Barna; Mazzitelli, Domenico; Lange, R.; Wiesner, Gunther; Tassani-Prell, Peter

doi:10.1097/sa.0000000000000248

Cited by 19 publications

(44 citation statements)

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“…Interestingly, the only RCT on the subject conversely reported a significantly increased length of ICU stay for the LAS group but without providing a rationale for this finding. 32 Graphical analysis of the length-of-stay data from studies that reported only the median and IQR/range produced a similar result as that of the meta-analysis, showing a shorter hospital stay in the LAS group. However, we could not confirm the finding of a shorter ICU stay in these studies.…”

Section: Length Of Staysupporting

confidence: 54%

“…18 30 31 36 In comparison, one study registered a significantly higher logistic EuroScore for the LAS group. 32 Other significant differences are shown in table 1.…”

Section: Study Selection and Eligibility Criteriamentioning

confidence: 82%

“…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%

“…We identified one eligible RCT that had a low risk of selection bias since adequate information concerning random sequence generation and allocation concealment was provided. 32 We evaluated all other studies as having a high risk of selection bias and performance bias due to the lack of randomisation and blinding of participants and personnel. Two studies were assessed as having a high risk of attrition bias because outcome data were not reported for all participants and no reason was provided for the missing data.…”

Section: Study Selection and Eligibility Criteriamentioning

confidence: 99%

“…Notably, the only eligible RCT found a statistically significant decrease in the length of ICU stay in the GA group. 32 dIscussIOn The present systematic review and meta-analysis evaluates the safety and clinical outcomes of TAVI under LAS compared with TAVI under GA. Our findings suggest that the two anaesthesia regimens, LAS and GA, are equally safe for TAVI, as we found no differences in 30-day mortality, in-hospital mortality and other endpoints addressing the safety and complication rates of TAVI. Patients who underwent LAS were less likely to require intra-and postprocedural catecholamine treatment and red blood cell transfusions.…”

Section: Length Of Staymentioning

confidence: 99%

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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: Length Of Staysupporting

confidence: 54%

“…18 30 31 36 In comparison, one study registered a significantly higher logistic EuroScore for the LAS group. 32 Other significant differences are shown in table 1.…”

Section: Study Selection and Eligibility Criteriamentioning

confidence: 82%

Section: Study Selection and Eligibility Criteriamentioning

confidence: 99%

Section: Study Selection and Eligibility Criteriamentioning

confidence: 99%

Section: Length Of Staymentioning

confidence: 99%

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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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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

105

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Periprocedural transfusion in patients undergoing transfemoral transcatheter aortic valve implantation

Mayr

Wiesner

Hapfelmeier

et al. 2017

Cathet Cardio Intervent

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Transfusion was considered necessary in 14% (n = 243) of the patients. Female gender (OR [95% CI]) (1.680 [1.014-2.783]) and preprocedural moderate (7.594 [4.404-13.095]) and severe anemia (8.202 [0.900-74.752]) according to WHO were the most important preprocedural variables. Periprocedural, pericardial effusion (12.109 [3.753-39.063]), emergency extracorporeal circulation (54.5288 [6.178-481.259]) and major vascular injury (2.647 [1.412-4.962]) were related to transfusion. The same applies to moderate (4.255 [1.859-9.740]) and severe anemia (31.567 [8.560-116.416]) as well as periprocedural experience (0.072 [0.035-0.149] - 0.141[0.079-0.251], P < 0.001) CONCLUSION: Procedural experience, serious adverse events, low pre- and periprocedural Hb levels and female gender were the main variables relating to transfusion. Even in experienced high-volume centers, transfusion is still necessary in a considerable number of patients.

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Comparison of Sedation and General Anaesthesia for Transcatheter Aortic Valve Implantation on Cerebral Oxygen Saturation and Neurocognitive Outcome

Cited by 19 publications

References 0 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

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

Periprocedural transfusion in patients undergoing transfemoral transcatheter aortic valve implantation

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