Comparison of transfemoral transcatheter aortic valve replacement under local versus general anesthesia in patients with aortic stenosis: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HAN Xiangxiang ¹ , LIU Shidong ² , WANG Jialu ¹ , LEI Xiang ¹ , WANG Zhenxiu ¹ , WANG Yujie ¹ , DONG Shuai ² ,  SONG Bing ²

1. The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, P. R. China;
2. Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Lanzhou, 730000, P. R. China;

Corresponding?author：

SONG Bing, Email: songbingldyy@163.com

Keywords：

Local anesthesia; general anesthesia; transfemoral transcatheter aortic valve replacement; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202103094

Video：

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Objective To systematically review the efficacy and safety of transfemoral transcatheter aortic valve replacement (TFTAVR) under local anesthesia (LA) and general anesthesia (GA). Methods Electronic databases including PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang and CBM were searched to collect randomized controlled trial and cohort studies on clinical outcomes of TFTAVR under LA and GA from inception to September 2020. Two authors independently screened literature, extracted data and assessed the quality of studies, and a meta-analysis was performed by using Stata 16.0 software. Results A total of 30 studies involving 52 087 patients were included in this study. There were 18 719 patients in the LA group and 33 368 patients in the GA group. The results of meta-analysis showed that the in-hospital all-cause mortality rate [RR=0.65, 95%CI (0.45, 0.94), P=0.021], 30-day all-cause mortality rate [RR=0.73, 95%CI (0.62, 0.86), P＜0.001], 30-day stroke [RR=0.82, 95%CI (0.68, 0.98), P=0.025], cardiac arrest [RR=0.50, 95%CI (0.34, 0.73), P＜0.001], ICU stay time [RR=?6.86, 95%CI (?12.31, ?1.42), P=0.013], and total hospital stay time [RR=?2.02, 95%CI (?2.59, ?1.45), P＜0.001] in the LA group were all better than those in the GA group. There was no significant difference in the in-hospital stroke [RR=0.83, 95%CI (0.69, 1.00), P=0.053], in-hospital myocardial infarction (MI) [RR=1.74, 95%CI (0.43, 7.00), P=0.434], or 30-day MI [RR=0.77, 95%CI (0.42, 1.42), P=0.404] between the two groups. Conclusion LA provides a safe and effective way to induce sedation without intubation, and may be a good alternative to GA for TFTAVR.

Citation： HAN Xiangxiang, LIU Shidong, WANG Jialu, LEI Xiang, WANG Zhenxiu, WANG Yujie, DONG Shuai, SONG Bing. Comparison of transfemoral transcatheter aortic valve replacement under local versus general anesthesia in patients with aortic stenosis: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(4): 597-604. doi: 10.7507/1007-4848.202103094 Copy

1.	高潤霖. 中國心瓣膜病現狀. 華西醫學, 2018, 33(2): 127-131.
2.	Cribier A, Eltchaninoff H, Bash A, et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: First human case description. Circulation, 2002, 106(24): 3006-3008.
3.	Sergi D, Acconcia MC, Muscoli S, et al. Meta-analysis of the impact on early and late mortality of TAVI compared to surgical aortic valve replacement in high and low-intermediate surgical risk patients. Eur Rev Med Pharmacol Sci, 2019, 23(12): 5402-5412.
4.	成澤怡, 郭應強. 經導管主動脈瓣置換術并發癥的最新進展. 中國胸心血管外科臨床雜志, 2019, 26(5): 494-498.
5.	程洋, 李茜, 李怡堅, 等. 經導管主動脈瓣置換術中局部麻醉和全身麻醉患者臨床結局的比較. 華西醫學, 2020, 35(9): 1055-1059.
6.	Jabbar A, Khurana A, Mohammed A, et al. Local versus general anesthesia in transcatheter aortic valve replacement. Am J Cardiol, 2016, 118(11): 1712-1716.
7.	Ramakrishna H, Patel PA, Gutsche JT, et al. Transcatheter aortic valve replacement: Clinical update on access approaches in the contemporary era. J Cardiothorac Vasc Anesth, 2016, 30(5): 1425-1429.
8.	朱達, 周瑩, 劉斌. 經食管實時三維超聲心動圖在心臟外科手術中的應用進展. 中國胸心血管外科臨床雜志, 2011, 18(4): 354-358.
9.	Motloch LJ, Rottlaender D, Reda S, et al. Local versus general anesthesia for transfemoral aortic valve implantation. Clin Res Cardiol, 2012, 101(1): 45-53.
10.	Fr?hlich GM, Lansky AJ, Webb J, et al. Local versus general anesthesia for transcatheter aortic valve implantation (TAVR)—Systematic review and meta-analysis. BMC Med, 2014, 12: 41.
11.	Maas EH, Pieters BM, Van de Velde M, et al. General or local anesthesia for TAVI? A systematic review of the literature and meta-analysis. Curr Pharm Des, 2016, 22(13): 1868-1878.
12.	Corbett MS, Higgins JP, Woolacott NF. Assessing baseline imbalance in randomised trials: Implications for the Cochrane risk of bias tool. Res Synth Methods, 2014, 5(1): 79-85.
13.	Cota GF, de Sousa MR, Fereguetti TO, et al. Efficacy of anti-leishmania therapy in visceral leishmaniasis among HIV infected patients: A systematic review with indirect comparison. PLoS Negl Trop Dis, 2013, 7(5): e2195.
14.	方廣, 張翠紅, 吳毅. 全身麻醉與局部麻醉在經導管主動脈瓣置換術中的安全性對比. 實用醫藥雜志, 2017, 34(11): 988-990.
15.	He W, Huang R, Shi Q, et al. Bispectral index-guided sedation in transfemoral transcatheter aortic valve implantation: A retrospective control study. J Zhejiang University-Sci B (Biomed & Biotech). 2017, 18(4): 353-359.
16.	Neumann FJ, Redwood S, Abdel-Wahab M, et al. General anesthesia or conscious sedation for transfemoral aortic valve replacement with the SAPIEN 3 transcatheter heart valve. Int Heart J, 2020, 61(4): 713-719.
17.	Lau WC, Shannon FL, Hanzel GS, et al. Transfemoral transcatheter aortic valve replacement using fascia iliaca block as an alternative approach to conscious sedation as compared to general anesthesia. Cardiovasc Revasc Med, 2020, 21(5): 594-601.
18.	Harjai KJ, Bules T, Berger A, et al. Efficiency, safety, and quality of life after transcatheter aortic valve implantation performed with moderate sedation versus general anesthesia. Am J Cardiol, 2020, 125(7): 1088-1095.
19.	Renner J, Tesdorpf A, Freitag-Wolf S, et al. A retrospective study of conscious sedation versus general anaesthesia in patients scheduled for transfemoral aortic valve implantation: A single center experience. Health Sci Rep, 2018, 2(1): e95.
20.	Mosleh W, Mather JF, Amer MR, et al. Propensity matched analysis comparing conscious sedation versus general anesthesia in transcatheter aortic valve implantation. Am J Cardiol, 2019, 124(1): 70-77.
21.	Bergmann L, Kahlert P, Eggebrecht H, et al. Transfemoral aortic valve implantation under sedation and monitored anaesthetic care—A feasibility study. Anaesthesia, 2011, 66(11): 977-982.
22.	Dehédin B, Guinot PG, Ibrahim H, et al. Anesthesia and perioperative management of patients who undergo transfemoral transcatheter aortic valve implantation: An observational study of general versus local/regional anesthesia in 125 consecutive patients. J Cardiothorac Vasc Anesth, 2011, 25(6): 1036-1043.
23.	Ben-Dor I, Looser PM, Maluenda G, et al. Transcatheter aortic valve replacement under monitored anesthesia care versus general anesthesia with intubation. Cardiovasc Revasc Med, 2012, 13(4): 207-210.
24.	D’Errigo P, Ranucci M, Covello RD, et al. Outcome after general anesthesia versus monitored anesthesia care in transfemoral transcatheter aortic valve replacement. J Cardiothorac Vasc Anesth, 2016, 30(5): 1238-1243.
25.	Yamamoto M, Meguro K, Mouillet G, et al. Effect of local anesthetic management with conscious sedation in patients undergoing transcatheter aortic valve implantation. Am J Cardiol, 2013, 111(1): 94-99.
26.	Fogel RI, Epstein AE, Mark Estes NA, et al. The disconnect between the guidelines, the appropriate use criteria, and reimbursement coverage decisions: The ultimate dilemma. J Am Coll Cardiol, 2014, 63(1): 12-14.
27.	Kiramijyan S, Ben-Dor I, Koifman E, et al. Comparison of clinical outcomes with the utilization of monitored anesthesia care vs. general anesthesia in patients undergoing transcatheter aortic valve replacement. Cardiovasc Revasc Med, 2016, 17(6): 384-390.
28.	Dall’Ara G, Eltchaninoff H, Moat N, et al. Local and general anaesthesia do not influence outcome of transfemoral aortic valve implantation. Int J Cardiol, 2014, 177(2): 448-454.
29.	Kesimci E, Erkili? E, Gümü? T, et al. Impact of different anesthetic managements in outcomes of transcatheteraortic valve implantation: The first Turkish experience. Turk J Med Sci, 2016, 46(3): 742-748.
30.	Mayr NP, Hapfelmeier A, Martin K, et al. Comparison of sedation and general anaesthesia for transcatheter aortic valve implantation on cerebral oxygen saturation and neurocognitive outcome. Br J Anaesth, 2016, 116(1): 90-99.
31.	Oguri A, Yamamoto M, Mouillet G, et al. Clinical outcomes and safety of transfemoral aortic valve implantation under general versus local anesthesia: Subanalysis of the French Aortic National CoreValve and Edwards 2 registry. Circ Cardiovasc Interv, 2014, 7(4):602-610.
32.	Attizzani GF, Alkhalil A, Padaliya B, et al. Comparison of outcomes of transfemoral transcatheter aortic valve implantation using a minimally invasive versus conventional strategy. Am J Cardiol, 2015, 116(11): 1731-1736.
33.	Husser O, Fujita B, Hengstenberg C, et al. Conscious sedation versus general anesthesia in transcatheter aortic valve replacement: The German Aortic Valve Registry. JACC Cardiovasc Interv, 2018, 11(6): 567-578.
34.	Eskandari M, Aldalati O, Dworakowski R, et al. Comparison of general anaesthesia and non-general anaesthesia approach in transfemoral transcatheter aortic valve implantation. Heart, 2018, 104(19): 1621-1628.
35.	Behan M, Haworth P, Hutchinson N, et al. Percutaneous aortic valve implants under sedation: Our initial experience. Catheter Cardiovasc Interv, 2008, 72(7): 1012-1015.
36.	Abud MA, Nau G, Candiello A, et al. Efficacy and safety of transfemoral transcatheter aortic valve replacement under general anesthesia versus local anesthesia with conscious sedation. Revista Argentina de Cardiologia, 2018, 86(1): 33-39.
37.	Stragier H, Dubois C, Verbrugghe P, et al. General anesthesia versus monitored anesthesia care for transfemoral transcatheter aortic valve implantation: A retrospective study in a single belgian referral center. J Cardiothorac Vasc Anesth, 2019, 33(12): 3283-3291.
38.	Akbaş S, Özkan AS. General anesthesia versus local anesthesia plus sedation in high risk patients underwent transcatheter aortic valve implantation (TAVI): A retrospective cohort study. Gogus-Kalp-Damar Anestezi ve Yogun Bakim Dernegi Dergisi, 2019, 25(1): 43-51.
39.	Hyman MC, Vemulapalli S, Szeto WY, et al. Conscious sedation versus general anesthesia for transcatheter aortic valve replacement: Insights from the National Cardiovascular Data Registry Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. Circulation, 2017, 136(22): 2132-2140.
40.	Attizzani GF, Patel SM, Dangas GD, et al. Comparison of local versus general anesthesia following transfemoral transcatheter self-expanding aortic valve implantation (from the Transcatheter Valve Therapeutics Registry). Am J Cardiol, 2019, 123(3): 419-425.
41.	Miles LF, Joshi KR, Ogilvie EH, et al. General anaesthesia vs. conscious sedation for transfemoral aortic valve implantation:A single UK centre before-and-after study. Anaesthesia, 2016, 71(8): 892-900.
42.	Guarracino F, Baldassarri R. The anesthetic management of transcatheter aortic valve implantation. Semin Cardiothorac Vasc Anesth, 2016, 20(2): 141-146.
43.	Marino M, Lilie CJ, Culp WC, et al. The evolution of echocardiographic type and anesthetic technique for transcatheter aortic valve replacement at a high-volume transcatheter aortic valve replacement center. J Cardiothorac Vasc Anesth, 2019, 33(1): 29-35.
44.	Van Mieghem NM, van der Boon RM, Nuis RJ, et al. Cause of death after transcatheter aortic valve implantation. Catheter Cardiovasc Interv, 2014, 83(7): E277-E282.
45.	Villablanca PA, Mohananey D, Nikolic K, et al. Comparison of local versus general anesthesia in patients undergoing transcatheter aortic valve replacement: A meta-analysis. Catheter Cardiovasc Interv, 2018, 91(2): 330-342.
46.	Creditor MC. Hazards of hospitalization of the elderly. Ann Intern Med, 1993, 118(3): 219-223.
47.	Convertino VA. Cardiovascular consequences of bed rest: Effect on maximal oxygen uptake. Med Sci Sports Exerc, 1997, 29(2): 191-196.
48.	Huded CP, Huded JM, Sweis RN, et al. The impact of delirium on healthcare utilization and survival after transcatheter aortic valve replacement. Catheter Cardiovasc Interv, 2017, 89(7): 1286-1291.
49.	Eide LS, Ranhoff AH, Fridlund B, et al. Readmissions and mortality in delirious versus non-delirious octogenarian patients after aortic valve therapy: A prospective cohort study. BMJ Open, 2016, 6(10): e012683.
50.	Brecker SJ, Bleiziffer S, Bosmans J, et al. Impact of anesthesia type on outcomes of transcatheter aortic valve implantation (from the Multicenter ADVANCE Study). Am J Cardiol, 2016,117(8):1332–1338.

1. 高潤霖. 中國心瓣膜病現狀. 華西醫學, 2018, 33(2): 127-131.
2. Cribier A, Eltchaninoff H, Bash A, et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: First human case description. Circulation, 2002, 106(24): 3006-3008.
3. Sergi D, Acconcia MC, Muscoli S, et al. Meta-analysis of the impact on early and late mortality of TAVI compared to surgical aortic valve replacement in high and low-intermediate surgical risk patients. Eur Rev Med Pharmacol Sci, 2019, 23(12): 5402-5412.
4. 成澤怡, 郭應強. 經導管主動脈瓣置換術并發癥的最新進展. 中國胸心血管外科臨床雜志, 2019, 26(5): 494-498.
5. 程洋, 李茜, 李怡堅, 等. 經導管主動脈瓣置換術中局部麻醉和全身麻醉患者臨床結局的比較. 華西醫學, 2020, 35(9): 1055-1059.
6. Jabbar A, Khurana A, Mohammed A, et al. Local versus general anesthesia in transcatheter aortic valve replacement. Am J Cardiol, 2016, 118(11): 1712-1716.
7. Ramakrishna H, Patel PA, Gutsche JT, et al. Transcatheter aortic valve replacement: Clinical update on access approaches in the contemporary era. J Cardiothorac Vasc Anesth, 2016, 30(5): 1425-1429.
8. 朱達, 周瑩, 劉斌. 經食管實時三維超聲心動圖在心臟外科手術中的應用進展. 中國胸心血管外科臨床雜志, 2011, 18(4): 354-358.
9. Motloch LJ, Rottlaender D, Reda S, et al. Local versus general anesthesia for transfemoral aortic valve implantation. Clin Res Cardiol, 2012, 101(1): 45-53.
10. Fr?hlich GM, Lansky AJ, Webb J, et al. Local versus general anesthesia for transcatheter aortic valve implantation (TAVR)—Systematic review and meta-analysis. BMC Med, 2014, 12: 41.
11. Maas EH, Pieters BM, Van de Velde M, et al. General or local anesthesia for TAVI? A systematic review of the literature and meta-analysis. Curr Pharm Des, 2016, 22(13): 1868-1878.
12. Corbett MS, Higgins JP, Woolacott NF. Assessing baseline imbalance in randomised trials: Implications for the Cochrane risk of bias tool. Res Synth Methods, 2014, 5(1): 79-85.
13. Cota GF, de Sousa MR, Fereguetti TO, et al. Efficacy of anti-leishmania therapy in visceral leishmaniasis among HIV infected patients: A systematic review with indirect comparison. PLoS Negl Trop Dis, 2013, 7(5): e2195.
14. 方廣, 張翠紅, 吳毅. 全身麻醉與局部麻醉在經導管主動脈瓣置換術中的安全性對比. 實用醫藥雜志, 2017, 34(11): 988-990.
15. He W, Huang R, Shi Q, et al. Bispectral index-guided sedation in transfemoral transcatheter aortic valve implantation: A retrospective control study. J Zhejiang University-Sci B (Biomed & Biotech). 2017, 18(4): 353-359.
16. Neumann FJ, Redwood S, Abdel-Wahab M, et al. General anesthesia or conscious sedation for transfemoral aortic valve replacement with the SAPIEN 3 transcatheter heart valve. Int Heart J, 2020, 61(4): 713-719.
17. Lau WC, Shannon FL, Hanzel GS, et al. Transfemoral transcatheter aortic valve replacement using fascia iliaca block as an alternative approach to conscious sedation as compared to general anesthesia. Cardiovasc Revasc Med, 2020, 21(5): 594-601.
18. Harjai KJ, Bules T, Berger A, et al. Efficiency, safety, and quality of life after transcatheter aortic valve implantation performed with moderate sedation versus general anesthesia. Am J Cardiol, 2020, 125(7): 1088-1095.
19. Renner J, Tesdorpf A, Freitag-Wolf S, et al. A retrospective study of conscious sedation versus general anaesthesia in patients scheduled for transfemoral aortic valve implantation: A single center experience. Health Sci Rep, 2018, 2(1): e95.
20. Mosleh W, Mather JF, Amer MR, et al. Propensity matched analysis comparing conscious sedation versus general anesthesia in transcatheter aortic valve implantation. Am J Cardiol, 2019, 124(1): 70-77.
21. Bergmann L, Kahlert P, Eggebrecht H, et al. Transfemoral aortic valve implantation under sedation and monitored anaesthetic care—A feasibility study. Anaesthesia, 2011, 66(11): 977-982.
22. Dehédin B, Guinot PG, Ibrahim H, et al. Anesthesia and perioperative management of patients who undergo transfemoral transcatheter aortic valve implantation: An observational study of general versus local/regional anesthesia in 125 consecutive patients. J Cardiothorac Vasc Anesth, 2011, 25(6): 1036-1043.
23. Ben-Dor I, Looser PM, Maluenda G, et al. Transcatheter aortic valve replacement under monitored anesthesia care versus general anesthesia with intubation. Cardiovasc Revasc Med, 2012, 13(4): 207-210.
24. D’Errigo P, Ranucci M, Covello RD, et al. Outcome after general anesthesia versus monitored anesthesia care in transfemoral transcatheter aortic valve replacement. J Cardiothorac Vasc Anesth, 2016, 30(5): 1238-1243.
25. Yamamoto M, Meguro K, Mouillet G, et al. Effect of local anesthetic management with conscious sedation in patients undergoing transcatheter aortic valve implantation. Am J Cardiol, 2013, 111(1): 94-99.
26. Fogel RI, Epstein AE, Mark Estes NA, et al. The disconnect between the guidelines, the appropriate use criteria, and reimbursement coverage decisions: The ultimate dilemma. J Am Coll Cardiol, 2014, 63(1): 12-14.
27. Kiramijyan S, Ben-Dor I, Koifman E, et al. Comparison of clinical outcomes with the utilization of monitored anesthesia care vs. general anesthesia in patients undergoing transcatheter aortic valve replacement. Cardiovasc Revasc Med, 2016, 17(6): 384-390.
28. Dall’Ara G, Eltchaninoff H, Moat N, et al. Local and general anaesthesia do not influence outcome of transfemoral aortic valve implantation. Int J Cardiol, 2014, 177(2): 448-454.
29. Kesimci E, Erkili? E, Gümü? T, et al. Impact of different anesthetic managements in outcomes of transcatheteraortic valve implantation: The first Turkish experience. Turk J Med Sci, 2016, 46(3): 742-748.
30. Mayr NP, Hapfelmeier A, Martin K, et al. Comparison of sedation and general anaesthesia for transcatheter aortic valve implantation on cerebral oxygen saturation and neurocognitive outcome. Br J Anaesth, 2016, 116(1): 90-99.
31. Oguri A, Yamamoto M, Mouillet G, et al. Clinical outcomes and safety of transfemoral aortic valve implantation under general versus local anesthesia: Subanalysis of the French Aortic National CoreValve and Edwards 2 registry. Circ Cardiovasc Interv, 2014, 7(4):602-610.
32. Attizzani GF, Alkhalil A, Padaliya B, et al. Comparison of outcomes of transfemoral transcatheter aortic valve implantation using a minimally invasive versus conventional strategy. Am J Cardiol, 2015, 116(11): 1731-1736.
33. Husser O, Fujita B, Hengstenberg C, et al. Conscious sedation versus general anesthesia in transcatheter aortic valve replacement: The German Aortic Valve Registry. JACC Cardiovasc Interv, 2018, 11(6): 567-578.
34. Eskandari M, Aldalati O, Dworakowski R, et al. Comparison of general anaesthesia and non-general anaesthesia approach in transfemoral transcatheter aortic valve implantation. Heart, 2018, 104(19): 1621-1628.
35. Behan M, Haworth P, Hutchinson N, et al. Percutaneous aortic valve implants under sedation: Our initial experience. Catheter Cardiovasc Interv, 2008, 72(7): 1012-1015.
36. Abud MA, Nau G, Candiello A, et al. Efficacy and safety of transfemoral transcatheter aortic valve replacement under general anesthesia versus local anesthesia with conscious sedation. Revista Argentina de Cardiologia, 2018, 86(1): 33-39.
37. Stragier H, Dubois C, Verbrugghe P, et al. General anesthesia versus monitored anesthesia care for transfemoral transcatheter aortic valve implantation: A retrospective study in a single belgian referral center. J Cardiothorac Vasc Anesth, 2019, 33(12): 3283-3291.
38. Akbaş S, Özkan AS. General anesthesia versus local anesthesia plus sedation in high risk patients underwent transcatheter aortic valve implantation (TAVI): A retrospective cohort study. Gogus-Kalp-Damar Anestezi ve Yogun Bakim Dernegi Dergisi, 2019, 25(1): 43-51.
39. Hyman MC, Vemulapalli S, Szeto WY, et al. Conscious sedation versus general anesthesia for transcatheter aortic valve replacement: Insights from the National Cardiovascular Data Registry Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. Circulation, 2017, 136(22): 2132-2140.
40. Attizzani GF, Patel SM, Dangas GD, et al. Comparison of local versus general anesthesia following transfemoral transcatheter self-expanding aortic valve implantation (from the Transcatheter Valve Therapeutics Registry). Am J Cardiol, 2019, 123(3): 419-425.
41. Miles LF, Joshi KR, Ogilvie EH, et al. General anaesthesia vs. conscious sedation for transfemoral aortic valve implantation:A single UK centre before-and-after study. Anaesthesia, 2016, 71(8): 892-900.
42. Guarracino F, Baldassarri R. The anesthetic management of transcatheter aortic valve implantation. Semin Cardiothorac Vasc Anesth, 2016, 20(2): 141-146.
43. Marino M, Lilie CJ, Culp WC, et al. The evolution of echocardiographic type and anesthetic technique for transcatheter aortic valve replacement at a high-volume transcatheter aortic valve replacement center. J Cardiothorac Vasc Anesth, 2019, 33(1): 29-35.
44. Van Mieghem NM, van der Boon RM, Nuis RJ, et al. Cause of death after transcatheter aortic valve implantation. Catheter Cardiovasc Interv, 2014, 83(7): E277-E282.
45. Villablanca PA, Mohananey D, Nikolic K, et al. Comparison of local versus general anesthesia in patients undergoing transcatheter aortic valve replacement: A meta-analysis. Catheter Cardiovasc Interv, 2018, 91(2): 330-342.
46. Creditor MC. Hazards of hospitalization of the elderly. Ann Intern Med, 1993, 118(3): 219-223.
47. Convertino VA. Cardiovascular consequences of bed rest: Effect on maximal oxygen uptake. Med Sci Sports Exerc, 1997, 29(2): 191-196.
48. Huded CP, Huded JM, Sweis RN, et al. The impact of delirium on healthcare utilization and survival after transcatheter aortic valve replacement. Catheter Cardiovasc Interv, 2017, 89(7): 1286-1291.
49. Eide LS, Ranhoff AH, Fridlund B, et al. Readmissions and mortality in delirious versus non-delirious octogenarian patients after aortic valve therapy: A prospective cohort study. BMJ Open, 2016, 6(10): e012683.
50. Brecker SJ, Bleiziffer S, Bosmans J, et al. Impact of anesthesia type on outcomes of transcatheter aortic valve implantation (from the Multicenter ADVANCE Study). Am J Cardiol, 2016,117(8):1332–1338.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Comparison of transfemoral transcatheter aortic valve replacement under local versus general anesthesia in patients with aortic stenosis: A systematic review and meta-analysis

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