Local anesthesia safe, effective in TAVR
Local anesthesia may be an alternative to general anesthesia in certain patients undergoing transcatheter aortic valve replacement, according to a meta-analysis published in Catheterization Cardiovascular Interventions.
Preliminary evidence from the study suggested that the use of local anesthesia for patients undergoing TAVR was linked to lower rates of 30-day mortality, shorter procedure and fluoroscopy time, ICU and hospital length of stay, and reduced need of inotropic support.
“TAVR is typically performed under general anesthesia with endotracheal intubation,” Pedro A. Villablanca, MD, MSc, from the division of cardiovascular disease at Montefiore Medical Center and Albert Einstein School of Medicine in New York, and colleagues, wrote. “However, growing clinical experience and advances in transcatheter technology have made TAVR feasible with both [general anesthesia] and local anesthesia, leading some centers to advocate a minimalist approach.”
The meta-analysis consisted of 10,572 patients from 26 randomized and nonrandomized studies and had a primary endpoint of 30-day all-cause mortality.
Researchers found an association between local anesthesia use for TAVR and a lower overall 30-day mortality rate (RR = 0.73; 95% CI, 0.57-0.93), use of inotropic/vasopressor drugs (RR = 0.45; 95% CI, 0.28-0.72), hospital length of stay (difference of the mean [DM] = 2.09 days; 95% CI, 3.02 to 1.16), ICU length of stay (DM = 0.18 days; 95% CI, 0.31 to 0.04), procedure time (DM = 25.02 minutes; 95% CI, 32.7 to 17.35) and fluoroscopy time (DM = 1.63 minutes; 95% CI, 3.02 to 0.24).
Villablanca and colleagues did not report any observed differences between the anesthesia types for stroke, CV mortality, MI, permanent pacemaker implantation, acute kidney injury, paravalvular leak, vascular complications, major bleeding, procedural success, conduction abnormalities or annular rupture.
“We believe that the consistent magnitude and direction of the overall effect, including the stable results after the sensitivity analyses, support the validity of our results and justify the conclusions,” the researchers wrote. “We also believe that the data we have presented contribute substantially to addressing the increasingly relevant issue of [local anesthesia] vs. [general anesthesia] for patients undergoing TAVR.” – by Dave Quaile
Disclosures: The authors report no relevant financial disclosures.