title: Is local anesthesia the optimum strategy in retrograde transcatheter aortic valve implantation? A systematic review and meta-analysis.
abstract: BACKGROUND
  Retrograde transcatheter aortic valve implantation (TAVI) can be performed under local anesthesia (LA) or general anesthesia (GA); however, a wide variation in practice exists.
  
  
  METHODS
  PubMed was searched between 2009 and 2013. Data were extracted from eligible studies. Random-effects meta-analysis was performed using DerSimonian Laird between-study variance.
  
  
  RESULTS
  There was no statistically significant difference identified between groups based on age or EuroSCORE. There was no statistically significant difference seen in all-cause mortality, or complication rates between groups. Mean procedural duration was 36 minutes shorter in the LA group (p = 0.001). There was increased vasopressor use in the GA group (odds ratio 3.92; p = 0.017). Mean hospital stay was 3.41 days shorter in the LA group (p = 0.018).
  
  
  CONCLUSIONS
  Results suggest that the use of LA for retrograde TAVI is feasible. There are several potential benefits associated, shorter procedural duration, and hospital stay with lower vasopressor requirements. Further studies and randomized trials are mandatory to confirm the presented findings and to identify those patients for whom LA would be appropriate.
authors.affiliation: Department of Cardiothoracic Surgery, Mater Misericordiae University Hospital, Mater Private Hospital, Dublin, Ireland.
authors.forename: Katie E
authors.initials: KE
authors.lastname: O' Sullivan
authors.affiliation: Department of Cardiothoracic Surgery, Mater Misericordiae University Hospital, Mater Private Hospital, Dublin, Ireland.
authors.forename: Darragh
authors.initials: D
authors.lastname: Bracken-Clarke
authors.affiliation: CSTAR Centre for Statistical Training and Research, University College Dublin, Dublin, Ireland.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Segurado
authors.affiliation: Department of Cardiothoracic Surgery, Mater Misericordiae University Hospital, Mater Private Hospital, Dublin, Ireland.
authors.forename: Mitchel
authors.initials: M
authors.lastname: Barry
authors.affiliation: Department of Cardiothoracic Surgery, Mater Misericordiae University Hospital, Mater Private Hospital, Dublin, Ireland.
authors.forename: Declan
authors.initials: D
authors.lastname: Sugrue
authors.affiliation: Department of Cardiothoracic Surgery, Mater Misericordiae University Hospital, Mater Private Hospital, Dublin, Ireland.
authors.forename: Georgina
authors.initials: G
authors.lastname: Flood
authors.affiliation: Department of Cardiothoracic Surgery, Mater Misericordiae University Hospital, Mater Private Hospital, Dublin, Ireland.
authors.forename: John
authors.initials: J
authors.lastname: Hurley
mesh_terms: D000768:Anesthesia, General / Q000009:adverse effects; D000772:Anesthesia, Local / Q000009:adverse effects; D001021:Aortic Valve / Q000503:physiopathology*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D006801:Humans; D007902:Length of Stay; D016017:Odds Ratio; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D014662:Vasoconstrictor Agents