• Adham Ahmed, Dave M Mathew, Serena M Mathew, Ahmed K Awad, Kathryn S Varghese, Sofia Khaja, Eamon Vega, Roshan Pandey, Jeremiah J Thomas, Christopher S Mathew, Sarah Ahmed, Jerrin George, Ayman K Awad, and Peter J Fusco.
• City University of New York School of Medicine, New York, NY. Electronic address: aahmed018@citymail.cuny.edu.
• J. Cardiothorac. Vasc. Anesth. 2023 Aug 1; 37 (8): 135813671358-1367.

ObjectivesFor patients with aortic stenosis, transcatheter aortic valve replacement (TAVR) offers a less invasive treatment modality than conventional surgical valve replacement. Although the surgery is performed traditionally under general anesthesia (GA), recent studies have described success with TAVR using local anesthesia (LA) and/or conscious sedation. The study authors performed a pairwise meta-analysis to compare the clinical outcomes of TAVR based on operative anesthesia management.DesignA random effects pairwise meta-analysis via the Mantel-Haenszel method.SettingNot applicable, as this is a meta-analysis.ParticipantsNo individual patient data were used.InterventionsNot applicable, as this is a meta-analysis.Measurements And Main ResultsThe authors comprehensively searched the PubMed, Embase, and Cochrane databases to identify studies comparing TAVR performed using LA or GA. Outcomes were pooled as risk ratios (RR) or standard mean differences (SMD) and their 95% CIs. The authors' pooled analysis included 14,388 patients from 40 studies (7,754 LA; 6,634 GA). Compared to GA TAVR, LA TAVR was associated with significantly lower rates of 30-day mortality (RR 0.69; p < 0.01) and stroke (RR 0.78; p = 0.02). Additionally, LA TAVR patients had lower rates of 30-day major and/or life-threatening bleeding (RR 0.64; p = 0.01), 30-day major vascular complications (RR 0.76; p = 0.02), and long-term mortality (RR 0.75; p = 0.009). No significant difference was seen between the 2 groups for a 30-day paravalvular leak (RR 0.88, p = 0.12).ConclusionsTranscatheter aortic valve replacement performed using LA is associated with lower rates of adverse clinical outcomes, including 30-day mortality and stroke. No difference was seen between the 2 groups for a 30-day paravalvular leak. These results support the use of minimally invasive forms of TAVR without GA.Copyright © 2023 Elsevier Inc. All rights reserved.

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