jeaa019.pdf (795.75 kB)
Comparing sedation vs. general anaesthesia in transoesophageal echocardiography-guided percutaneous transcatheter mitral valve repair: a meta-analysis
journal contributionposted on 2023-07-21, 16:02 authored by Sandeep Banga, Abdul Moiz Hafiz, Youssef Chami, Darrel C Gumm, Preeti Banga, Carmen HowardCarmen Howard, Min-Chul KimMin-Chul Kim, Partho P Sengupta
AIMS: Transoesophageal echocardiography-guided percutaneous transcatheter mitral valve repair (TOE-guided PMVR) using edge-to-edge leaflet plication is typically performed under general anaesthesia (GA). Increasing evidence supports the efficacy and safety of PMVR performed under conscious sedation (CS) or deep sedation (DS). We performed a meta-analysis comparing safety and efficacy of CS/DS vs. GA in PMVR. METHODS AND RESULTS: A comprehensive search was performed using PubMed, CINAHL, Ovid MEDLINE, Embase, and the Cochrane Library. Study characteristics, participant demographics, and procedural outcomes with both types of anaesthesia were analysed. Out of 73 articles, five met inclusion criteria. Overall, there was no significant difference in the primary outcome of procedural success rate [odds ratio (OR) 0.75; 95% confidence interval (CI) 0.30-1.88, I2= 0.0%, P = 0.538] or post-procedure in-hospital mortality (OR 1.02; 95% CI 0.38-2.71, I2= 0.0%, P = 0.970) in the patients undergoing PMVR under CS/DS vs. GA. The secondary endpoint of intensive care unit (ICU) length of stay (LOS) was significantly shorter in patients under CS/DS vs. GA (standardized mean difference, SMD = -0.97; 95% CI -1.75 to -0.20; P = 0.014), but the hospital LOS (SMD = 0.36; 95% CI -0.77 to 0.04, P = 0.078) did not show a statistically significant difference between the groups, although it was shorter in the CS/DS group. No difference was observed between CS/DS and GA in fluoroscopy time, procedure time, or complications, including pneumonia, stroke/transient ischaemic attack, and major bleeding. CONCLUSION: CS or DS has lower ICU LOS, but comparable procedural success rate and in-hospital mortality, making it a potential alternative to GA for TOE-guided PMVR.
CitationBanga, S., Hafiz, A. M., Chami, Y., Gumm, D. C., Banga, P., Howard, C., Kim, M.Sengupta, P. P. (2020). Comparing sedation vs. general anaesthesia in transoesophageal echocardiography-guided percutaneous transcatheter mitral valve repair: a meta-analysis. European Heart Journal - Cardiovascular Imaging, 21(5), 511-521. https://doi.org/10.1093/ehjci/jeaa019
PublisherOxford University Press (OUP)
32 Biomedical and Clinical Sciences3202 Clinical SciencesCardiovascular3 Good Health and Well BeingAnesthesia, GeneralEchocardiography, TransesophagealHumansMitral ValveTime FactorsTreatment Outcomeconscious sedationdeep sedationgeneral anaesthesiapercutaneous transcatheter mitral valve repair3201 Cardiovascular medicine and haematology