The hypothesis of this study was that local anesthesia with monitored anesthesia care (MAC) is not harmful in comparison to general anesthesia (GA) for patients undergoing Transcatheter Aortic Valve Implantation (TAVR).TAVR is a rapidly spreading treatment option for severe aortic valve stenosis. Traditionally, in most centers, this procedure is done under GA, but more recently procedures with MAC have been reported.
Methods:
This is a systematic review and meta-analysis comparing MAC versus GA in patients undergoing transfemoral TAVR.
Trials were identified through a literature search covering publications from 1January 2005 through 31 January 2013. The main outcomes of interest of this literature meta-analysis were 30-day overall mortality, cardiac-/procedure-related mortality, stroke, myocardial infarction, sepsis, acute kidney injury, procedure time and durationof hospital stay.
A random effects model was used to calculate the pooled relative risks (RR) with 95% confidence intervals.
Results:
Seven observational studies and a total of 1,542 patients were included in this analysis. None of the studies were randomized.
Compared to GA, MAC was associated with a shorter hospital stay (-3.0 days (-5.0 to -1.0); P = 0.004) and a shorter procedure time (MD -36.3 minutes (-58.0 to -15.0 minutes); P
Conclusion:
These data did not show a significant difference in short-term outcomes for MAC or GA in TAVR.
MAC may be associated with reduced procedural time and shorter hospital stay. Now randomized trials are needed for further evaluation of MAC in the setting of TAVR.
Author: Georg M FröhlichAlexandra J LanskyJohn WebbMarco RoffiStefan ToggweilerMarkus ReinthalerDuolao WangNevil HutchinsonOlaf WendlerDavid Hildick-SmithPascal Meier
Credits/Source: BMC Medicine 2014, 12:41
Published on: 2014-03-10
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