The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Interventions for valvular disease and heart failure

Deep sedation versus general anaesthesia for transcatheter mitral valve repair: an individual patient data meta-analysis of observational studies

EuroIntervention 2021;16:1359-1365. DOI: 10.4244/EIJ-D-20-00607

1. Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology, and Leipzig Heart Institute, Leipzig, Germany; 2. Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, University of Lübeck, Lübeck, Germany; 3. German Center for Cardiovascular Research (DZHK), Berlin, Germany; 4. Leibniz Institute for Science and Mathematics Education Kiel, Kiel, Germany; 5. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; 6. CardioVascular Center Frankfurt, Frankfurt, Germany; 7. Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany; 8. Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany; 9. Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University Tübingen, Tübingen, Germany

Aims: The aim of this meta-analysis was to compare general anaesthesia (GA) and deep sedation (DS) with regard to safety and length of intensive care unit (ICU) stay in patients undergoing percutaneous edge-to-edge mitral valve repair (PMVR).

Methods and results: Four studies comparing GA and DS in patients undergoing PMVR were included in an individual patient data meta-analysis. Data were pooled after multiple imputation. The composite safety endpoint of all-cause death, stroke, pneumonia, or major to life-threatening bleeding occurred in 87 of 626 (13.9%) patients with no difference between patients treated with DS as compared to GA (56 and 31 events in 420 and 206 patients, respectively). In this regard, the odds ratio (OR) was 1.27 (95% confidence interval [CI]: 0.78 to 2.09; p=0.338) and 1.26 (95% CI: 0.49 to 3.22; p=0.496) following the one-stage and two-stage approach, respectively. Length of ICU stay was longer after GA as compared to DS (ratio of days 3.08, 95% CI: 2.18 to 4.36, p<0.001, and 2.88, 95% CI: 1.45 to 5.73, p=0.016, following the one-stage and two-stage approach, respectively).

Conclusions: Both DS and GA might offer a similar safety profile. However, ICU stay seems to be shorter after DS.

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