Comparing Local and General Anesthesia in Transcatheter Aortic Valve Implantation

In a report in The Heart Surgery Forum, researchers presented a meta-analysis that compared the efficacies of local anesthesia (LA) and general anesthesia (GA) during transcatheter aortic valve implantation (TAVI) surgery for patients with aortic stenosis (AS). The study’s lead author, Lulu Gao, and colleagues ultimately concluded that LA, with or without sedation, and GA were both feasible and safe.

The analysis included 17 studies comprised of 20,938 patients that were published to the PubMed, Embase, Web of Science, and the Cochrane Library databases. The primary measures of the study were 30-day mortality, procedural time, new pacemaker implantation rate, total hospital stay, vasoactive drug use, and intra- and postoperative complications and emergencies.

According to the authors, complications including myocardial infarction, vascular complication, renal injury/failure, stroke, and cardiac tamponade were not significantly different with LA compared to with GA in patients with severe AS undergoing TVAI. Furthermore, no differences were observed in new pacemaker implantation, total hospital stay, transesophageal echocardiography, and emergency percutaneous coronary intervention (PCI).

Notably, LA demonstrated several advantages compared to GA, including lower mortality (risk ratio [RR] 0.69; P=.600), pulmonary complications (RR 0.54; P=.278), life-threatening or major bleeding events (RR 0.85; P=.855), lower conversion times to open (RR 0.22; P=.746), shorter procedure duration (mean difference [MD] –0.38; P=.000), and reduced use of vasoactive drugs (RR 0.57; P=.000).

In short, the researchers proposed that “LA appears a feasible alternative to GA for AS patients undergoing TAVI.”