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

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

doi:10.3389/fcvm.2022.1099959

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

Front Cardiovasc Med. 2023 Jan 10:9:1099959. doi: 10.3389/fcvm.2022.1099959. eCollection 2022.

Authors

Kuo-Chuan Hung^{1

2}, Jen-Yin Chen², Chung-Hsi Hsing^{2

3}, Chin-Chen Chu², Yao-Tsung Lin², Yu-Li Pang², I-Chia Teng², I-Wen Chen⁴, Cheuk-Kwan Sun^{5

6}

Affiliations

¹ School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung City, Taiwan.
² Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan.
³ Department of Medical Research, Chi Mei Medical Center, Tainan City, Taiwan.
⁴ Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan City, Taiwan.
⁵ Department of Emergency Medicine, E-Da Hospital, Kaohsiung City, Taiwan.
⁶ College of Medicine, I-Shou University, Kaohsiung City, Taiwan.

Abstract

Background: 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).

Measurements: 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)].

Main results: Twenty-four studies (observational studies, n = 22; RCTs, n = 2) involving 141,965 patients were analyzed. Pooled results revealed lower risks of 30-day mortality [odd ratios (OR) = 0.66, p < 0.00001, 139,731 patients, certainty of evidence (COE): low], one-year mortality (OR = 0.72, p = 0.001, 4,827 patients, COE: very low), major bleeding (OR = 0.61, p = 0.01, 6,888 patients, COE: very low), acute kidney injury (OR = 0.71, p = 0.01, 7,155 patients, COE: very low), vasopressor/inotropic support (OR = 0.25, p < 0.00001, 133,438 patients, COE: very low), shorter procedure time (MD = -12.27 minutes, p = 0.0006, 17,694 patients, COE: very low), intensive care unit stay (mean difference(MD) = -7.53 h p = 0.04, 7,589 patients, COE: very low), and hospital stay [MD = -0.84 days, p < 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.

Conclusion: 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.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42022367417.

Keywords: aortic stenosis; conscious sedation; meta-analysis; monitored anesthesia care; prognostic outcomes; transcatheter aortic valve replacement.

Publication types

Systematic Review