Comparing sedation vs. general anaesthesia in transoesophageal echocardiography-guided percutaneous transcatheter mitral valve repair: a meta-analysis

Author:

Banga Sandeep1ORCID,Hafiz Abdul Moiz2,Chami Youssef2,Gumm Darrel C3,Banga Preeti4,Howard Carmen5,Kim Minchul6,Sengupta Partho P1

Affiliation:

1. Division of Cardiology, West Virginia University School of Medicine, 1 Medical Center Drive, Morgantown, WV, USA

2. Division of Cardiology, Southern Illinois University School of Medicine, Springfield, IL, USA

3. Division of Cardiology, University of Illinois College of Medicine at Peoria, OSF Saint Francis Medical Center, Peoria, IL, USA

4. University of Illinois College of Medicine at Peoria, OSF Saint Francis Medical Center, Peoria, IL, USA

5. Library of the Health Sciences at Peoria, University of Illinois at Chicago, Peoria, IL, USA

6. Center of Outcomes Research, Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA

Abstract

Abstract 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.

Funder

NIH

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine,Radiology Nuclear Medicine and imaging,General Medicine

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