General or Local Anesthesia for TAVI? A Systematic Review of the Literature and Meta-Analysis

Maas, E. H. A.; Pieters, B. M. A.; Velde, M. Van de; Rex, Steffen

doi:10.2174/1381612822666151208121825

Cited by 59 publications

(64 citation statements)

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“…A meta-analysis comprising 5919 patients also showed an association between the non-GA TAVI and paravalvular AR 18. One suggested explanation for the findings in the FRANCE 2 registry was the lack of intraprocedural TOE in the non-GA TAVI.…”

Section: Discussionmentioning

confidence: 94%

Comparison of general anaesthesia and non-general anaesthesia approach in transfemoral transcatheter aortic valve implantation

Eskandari

Aldalati

Dworakowski

et al. 2018

Heart

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Section: Discussionmentioning

confidence: 94%

Comparison of general anaesthesia and non-general anaesthesia approach in transfemoral transcatheter aortic valve implantation

Eskandari

Aldalati

Dworakowski

et al. 2018

Heart

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“…Thus, our article adds important new information to the decision-making process concerning the optimum anaesthetic strategy and strengthens the evidence supporting the safety of LAS for TAVI that has been indicated in previous systematic reviews. [37][38][39] LAS provides multiple benefits compared with GA. These benefits are even more valuable in a patient population characterised by old age and a high level of frailty, as in the case of patients undergoing TAVI for aortic stenosis.…”

Section: Length Of Staymentioning

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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“…Maas et al [21] carried out a meta-analysis of data from 5,919 patients. They demonstrated that neither mortality nor the incidence of major adverse cardiac and cerebrovascular events after TAVI is affected by the choice of either local anaesthesia or general anaesthesia.…”

Section: Discussionmentioning

confidence: 99%

Local anaesthesia with analgosedation in patients qualified for transcatheter aortic valve implantation (TAVI): first institute’s results and experiments

Musiał

Lipińska-Strasik

Piątkiewicz

et al. 2017

Anaesthesiol Intensive Ther

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Background: The authors present their own experience of the treatment of patients qualified for transcatheter aortic valve implantation (TAVI) carried out in a modern hybrid operating room. The objective of the present study was to demonstrate the initial results of conducting anaesthesia in high-risk patients qualified for the TAVI procedure (transcatheter aortic valve implantation). In addition, the authors' aim was also to point out to the special challenges of an anaesthesiologist conducting local anaesthesia in such a type of procedures and to evaluate the safety and efficacy of the TAVI procedure conducted under remifentanil analgosedation. Methods: A retrospective analysis included patients treated during the period from September 2015, when local anaesthesia for the transcatheter aortic valve implantation was used for the first time at our centre, up to February 2016. The studied population consisted of 11 patients treated for severe aortic valve stenosis. The mean age of patients was 80 ± 7 years. Three patients were men (27%) and eight were women (73%). The study included all subsequent patients (n = 11), treated in our centre, for whom it was decided to perform TAVI under local anaesthesia. Results: The total hospital mortality rate was 0%. All procedures were performed in a hybrid operating room. Despite the complications observed in the described group, the hospital mortality rate during TAVI was 0%. All patients, after 12 ± 5 days of treatment, left the hospital in a good neurological condition, which was assessed based on the CPC-1 (Cerebra Performance Categories Scale) and GCS-15 (Glasgow Coma Scale) scales. With an ejection fraction of the left ventricle of 53 ± 11%, the transcatheter aortic valve was successfully implanted. Conclusions: Percutaneous aortic valve implantation can be successfully conducted under remifentanil analgosedation. TAVI procedures should be performed in the conditions of a modern, well-equipped hybrid room. The aim of the anaesthesiologist should consist of conducting the least invasive anaesthesia/analgesia, bearing in mind the safety and comfort of the patient.

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General or Local Anesthesia for TAVI? A Systematic Review of the Literature and Meta-Analysis

Abstract: Neither mortality nor the incidence of major adverse cardiac and cerebrovascular events after TAVI is affected by the choice for either LRA or GA.

Cited by 59 publications

References 0 publications

Comparison of general anaesthesia and non-general anaesthesia approach in transfemoral transcatheter aortic valve implantation

Comparison of general anaesthesia and non-general anaesthesia approach in transfemoral transcatheter aortic valve implantation

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

Local anaesthesia with analgosedation in patients qualified for transcatheter aortic valve implantation (TAVI): first institute’s results and experiments

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