A minimalist approach to transcatheter aortic valve replacement (TAVR) involving local anesthesia appears to have several advantages, according to this new meta-analysis.
In addition to shortening times for procedures and lengths of stay in the critical care unit and hospital, lighter sedation may lower the need for transfusions or treatment with inotropes or vasopressors.
Those benefits do not come with clinical complications. In fact, mortality at 30 days was lower in those receiving TAVR with local anesthesia (3.7% vs. 4.2%; risk ratio [RR]: 0.76; 95% confidence interval [CI]: 0.64-0.92).
In the earlier days of TAVR, procedures were typically performed under general anesthesia with orotracheal intubation. However, in time, accumulating evidence suggested that using local anesthesia in the procedure, as part of a minimalist approach, is not only feasible but also beneficial.
While the meta-analysis is not to be considered as definitive evidence as regards hard endpoints such as mortality, a minimalist strategy presents enough advantages to support its application.
This meta-analysis included 27 studies and a total of 24,085 patients.
Most procedural variables turned out to be similar for both strategies, including rates of stroke, acute myocardial infarction, renal failure, vascular complications, major bleeding, a need for a permanent pacemaker, paravalvular insufficiency, or fluoroscopy time.
Patients who received local anesthesia presented the following advantages:
- a shorter average procedure time (90 vs. 127 minutes),
- less time in the critical care unit (1.5 vs. 3.0 days),
- less time in the hospital (5 vs 9 days),
- possibly, lower mortality (although this conclusion might be biased).
Original title: Comparison of Local Versus General Anesthesia in Patients Undergoing Transcatheter Aortic Valve Replacement: A Meta-Analysis and Meta-Regression.
Presenter: Villablanca PA.
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