Patient Selection and Outcomes of Transfemoral Transcatheter Aortic Valve Replacement Performed with Monitored Anesthesia Care Versus General Anesthesia

TCT-664 Comparison of General versus Local Anesthesia in Patients Undergoing Transcatheter Aortic Valve Replacement (TAVR): A Meta-analysis

“…Results are expressed as Mantel Haenszel Risk Ratio (RR) or mean difference (MD) with 95% confidence intervals (CI) [1]. In addition to the 26 studies included in our previous analysis, we found 6 new studies (with 12,453 patients) meeting our inclusion criteria [2][3][4][5][6][7].…”

Sedation Versus General Anesthesia for TAVR: Where Do We Go From Here?

“…In this issue, Pani et al report 5 results from a cohort of 104 consecutive patients who underwent transfemoral TAVR under either monitored anesthesia care (MAC) (n ¼ 60) or general anesthesia (n ¼ 37). Several prespecified criteria were used to guide the anesthetic choice, including predicted difficult airway, difficult access, obesity (body mass index 435 kg/m 2 ), severe obstructive sleep apnea, and inability to follow commands.…”

“…The decision to administer MAC versus general anesthesia is not random, with the result that patients in one arm may be sicker and expected to have worse outcomes. Indeed, in the Pani et al 5 article, it is important to note that patients in the general anesthesia group were readmitted more frequently and had longer procedural times-both indicators that the general anesthesia group may have had more baseline comorbidity. Additionally, patients who required conversion to general anesthesia were removed from the analysis, thus introducing potential bias since patients with more complications were not included in the MAC group.…”

“…8 Third, small studies may not be powered to show differences in important outcomes. The study by Pani et al 5 reported outcome data on only 97 patients, and this small sample size is typical for studies in this area. Unfortunately, important differences in outcomes may be obscured due to reduced power to detect a difference.…”

“…Finally, Pani et al 5 reported a high conversion rate (10%) from MAC to general anesthesia, in spite of predefined criteria for anesthesia choice. Although other groups have reported lower rates, 8 this rate was similar to that reported in one of the largest US-based studies.…”