title: Local versus general anesthesia for transcatheter aortic valve implantation (TAVR)--systematic review and meta-analysis.
abstract: BACKGROUND
  The hypothesis of this study was that local anesthesia with monitored anesthesia care (MAC) is not harmful in comparison to general anesthesia (GA) for patients undergoing Transcatheter Aortic Valve Implantation (TAVR).TAVR is a rapidly spreading treatment option for severe aortic valve stenosis. Traditionally, in most centers, this procedure is done under GA, but more recently procedures with MAC have been reported.
  
  
  METHODS
  This is a systematic review and meta-analysis comparing MAC versus GA in patients undergoing transfemoral TAVR. Trials were identified through a literature search covering publications from 1 January 2005 through 31 January 2013. The main outcomes of interest of this literature meta-analysis were 30-day overall mortality, cardiac-/procedure-related mortality, stroke, myocardial infarction, sepsis, acute kidney injury, procedure time and duration of hospital stay. A random effects model was used to calculate the pooled relative risks (RR) with 95% confidence intervals.
  
  
  RESULTS
  Seven observational studies and a total of 1,542 patients were included in this analysis. None of the studies were randomized. Compared to GA, MAC was associated with a shorter hospital stay (-3.0 days (-5.0 to -1.0); P = 0.004) and a shorter procedure time (MD -36.3 minutes (-58.0 to -15.0 minutes); P <0.001). Overall 30-day mortality was not significantly different between MAC and GA (RR 0.77 (0.38 to 1.56); P = 0.460), also cardiac- and procedure-related mortality was similar between both groups (RR 0.90 (0.34 to 2.39); P = 0.830).
  
  
  CONCLUSIONS
  These data did not show a significant difference in short-term outcomes for MAC or GA in TAVR. MAC may be associated with reduced procedural time and shorter hospital stay. Now randomized trials are needed for further evaluation of MAC in the setting of TAVR.
authors.forename: Georg M
authors.initials: GM
authors.lastname: Fröhlich
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Lansky
authors.forename: John
authors.initials: J
authors.lastname: Webb
authors.forename: Marco
authors.initials: M
authors.lastname: Roffi
authors.forename: Stefan
authors.initials: S
authors.lastname: Toggweiler
authors.forename: Markus
authors.initials: M
authors.lastname: Reinthaler
authors.forename: Duolao
authors.initials: D
authors.lastname: Wang
authors.forename: Nevil
authors.initials: N
authors.lastname: Hutchinson
authors.forename: Olaf
authors.initials: O
authors.lastname: Wendler
authors.forename: David
authors.initials: D
authors.lastname: Hildick-Smith
authors.affiliation: The Heart Hospital, University College London Hospitals, London, UK. pascalmeier74@gmail.com.
authors.forename: Pascal
authors.initials: P
authors.lastname: Meier
mesh_terms: D000368:Aged; D000768:Anesthesia, General; D000772:Anesthesia, Local; D001024:Aortic Valve Stenosis / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay; D012306:Risk; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D016896:Treatment Outcome