Comparison of transfemoral transcatheter aortic valve replacement under local versus general anesthesia in patients with aortic stenosis: A systematic review and meta-analysis
- VernacularTitle:主动脉瓣狭窄患者在局部麻醉和全身麻醉下行经股动脉经导管主动脉瓣置换术比较的系统评价与Meta分析
- Author:
Xiangxiang HAN
1
;
Shidong LIU
2
;
Jialu WANG
1
;
Xiang LEI
1
;
Zhenxiu WANG
1
;
Yujie WANG
1
;
Shuai DONG
2
;
Bing SONG
2
Author Information
1. The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, P. R. China
2. Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Lanzhou, 730000, P. R. China
- Publication Type:Journal Article
- Keywords:
Local anesthesia;
general anesthesia;
transfemoral transcatheter aortic valve replacement;
systematic review/meta-analysis
- From:
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
2023;30(04):597-604
- CountryChina
- Language:Chinese
-
Abstract:
Objective To systematically review the efficacy and safety of transfemoral transcatheter aortic valve replacement (TFTAVR) under local anesthesia (LA) and general anesthesia (GA). Methods Electronic databases including PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang and CBM were searched to collect randomized controlled trial and cohort studies on clinical outcomes of TFTAVR under LA and GA from inception to September 2020. Two authors independently screened literature, extracted data and assessed the quality of studies, and a meta-analysis was performed by using Stata 16.0 software. Results A total of 30 studies involving 52 087 patients were included in this study. There were 18 719 patients in the LA group and 33 368 patients in the GA group. The results of meta-analysis showed that the in-hospital all-cause mortality rate [RR=0.65, 95%CI (0.45, 0.94), P=0.021], 30-day all-cause mortality rate [RR=0.73, 95%CI (0.62, 0.86), P<0.001], 30-day stroke [RR=0.82, 95%CI (0.68, 0.98), P=0.025], cardiac arrest [RR=0.50, 95%CI (0.34, 0.73), P<0.001], ICU stay time [RR=−6.86, 95%CI (−12.31, −1.42), P=0.013], and total hospital stay time [RR=−2.02, 95%CI (−2.59, −1.45), P<0.001] in the LA group were all better than those in the GA group. There was no significant difference in the in-hospital stroke [RR=0.83, 95%CI (0.69, 1.00), P=0.053], in-hospital myocardial infarction (MI) [RR=1.74, 95%CI (0.43, 7.00), P=0.434], or 30-day MI [RR=0.77, 95%CI (0.42, 1.42), P=0.404] between the two groups. Conclusion LA provides a safe and effective way to induce sedation without intubation, and may be a good alternative to GA for TFTAVR.
