Open Access

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

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Date: 26 February 2020
Journal: European Heart Journal - Cardiovascular Imaging , Volume 21 , Issue 5 , Pages 511 - 521
Authors: S. Banga , A. Hafiz , Y. Chami , D. Gumm , P. Banga , C. Howard , M. Kim , P. Sengupta

ESC Journals

AbstractAims

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.

About the contributors

Sandeep Banga

Role: Author

Abdul Moiz Hafiz

Role: Author

Youssef Chami

Role: Author