Comparative efficacy of local and general anesthesia for transcatheter aortic valve implantation: a meta-analysis and systematic review

Background: This meta-analysis aimed to compare the potential effects of local anesthesia (LA) and general anesthesia (GA) for transcather aortic value implantation (TAVI). Measurements All relevant studies were searched from the Pubmed, EMbase, Web of Science and the Cochrane Library (January 1, 2016 to June 1, 2021). The main outcomes of this literature meta-analysis were 30-day mortality, procedural time, new pacemaker implantation, total stay in hospital, the use of vasoactive drug, intra-and postoperative complications and emergencies, including conversion to open, myocardial infraction, pulmonary complication, vascular complication, renal injury/failure, stroke, transesophageal echocardiography, life-threatening/major bleeding, cardiac tamponade, emergency PCI. Pooled risk ratio (RR) and mean difference (MD) together with 95% confidence interval (CI) were calculated. Results A total of seventeen studies including 20938 patients in the final analysis fulfilled the inclusion criteria. Intra-and postoperative complications (myocardial infraction, vascular complication, renal injury/failure, stoke, cardiac tamponade) undergoing TAVI in serious AS patients under GA do not offer significant difference compared with LA. No differences are observed between LA and GA for new pacemaker implantation, total stay in hospital, transesophageal echocardiography, emergency PCI. GA is associated with more adverse events, like the more overall mortality (RR 0.69, p=0.600), pulmonary complications (RR 0.54, p=0.278), life-threatening/major bleeding (RR 0.85, p=0.855), the more times of coversion to open (RR 0.22, p=0.746). LA has many advantages, including a shorter procedure duration (MD=-0.38, p=0.000) and a reduction of the use of vasoactive drug (RR 0.57，P=0.000). Conclusions For TAVI, both LA with or without sedation and GA are feasible and safe. LA appears a feasible alternative to GA for AS patients undergo TAVI.