AUTHOR=Hung Kuo-Chuan , Chen Jen-Yin , Hsing Chung-Hsi , Chu Chin-Chen , Lin Yao-Tsung , Pang Yu-Li , Teng I-Chia , Chen I-Wen , Sun Cheuk-Kwan 

TITLE=Conscious sedation/monitored anesthesia care versus general anesthesia in patients undergoing transcatheter aortic valve replacement: A meta-analysis

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=9

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.1099959

DOI=10.3389/fcvm.2022.1099959

ISSN=2297-055X

ABSTRACT=<sec><title>Background</title><p>To compare the merits and safety between conscious sedation/monitored anesthesia (CS/MAC) and general anesthesia (GA) for patients receiving transcatheter aortic valve replacement (TAVR).</p></sec><sec><title>Measurements</title><p>Databases including EMBASE, MEDLINE, and the Cochrane Library databases were searched from inception to October 2022 to identify studies investigating the impact of CS/MAC on peri-procedural and prognostic outcomes compared to those with GA. The primary outcome was the association of CS/MAC with the risk of 30-day mortality, while secondary outcomes included the risks of adverse peri-procedural (e.g., vasopressor/inotropic support) and post-procedural (e.g., stroke) outcomes. Subgroup analysis was performed based on study design [i.e., cohort vs. matched cohort/randomized controlled trials (RCTs)].</p></sec><sec><title>Main results</title><p>Twenty-four studies (observational studies, <italic>n</italic> = 22; RCTs, <italic>n</italic> = 2) involving 141,965 patients were analyzed. Pooled results revealed lower risks of 30-day mortality [odd ratios (OR) = 0.66, <italic>p</italic> &lt; 0.00001, 139,731 patients, certainty of evidence (COE): low], one-year mortality (OR = 0.72, <italic>p</italic> = 0.001, 4,827 patients, COE: very low), major bleeding (OR = 0.61, <italic>p</italic> = 0.01, 6,888 patients, COE: very low), acute kidney injury (OR = 0.71, <italic>p</italic> = 0.01, 7,155 patients, COE: very low), vasopressor/inotropic support (OR = 0.25, <italic>p</italic> &lt; 0.00001, 133,438 patients, COE: very low), shorter procedure time (MD = −12.27 minutes, <italic>p</italic> = 0.0006, 17,694 patients, COE: very low), intensive care unit stay (mean difference(MD) = −7.53 h <italic>p</italic> = 0.04, 7,589 patients, COE: very low), and hospital stay [MD = −0.84 days, <italic>p</italic> &lt; 0.00001, 19,019 patients, COE: very low) in patients receiving CS/MAC compared to those undergoing GA without significant differences in procedure success rate, risks of cardiac-vascular complications (e.g., myocardial infarction) and stroke. The pooled conversion rate was 3.1%. Results from matched cohort/RCTs suggested an association of CS/MAC use with a shorter procedural time and hospital stay, and a lower risk of vasopressor/inotropic support.</p></sec><sec><title>Conclusion</title><p>Compared with GA, our results demonstrated that the use of CS/MAC may be feasible and safe in patients receiving TAVR. However, more evidence is needed to support our findings because of our inclusion of mostly retrospective studies.</p></sec><sec><title>Systematic review registration</title><p><ext-link ext-link-type="uri" xlink:href="https://www.crd.york.ac.uk/prospero/" xmlns:xlink="http://www.w3.org/1999/xlink">https://www.crd.york.ac.uk/prospero/</ext-link>, identifier CRD42022367417.</p></sec>