Effect of general anesthesia on postoperative outcomes of transcatheter aortic valve implantation in patients: a systematic review and meta-analysis
Objective The optimal mode of anesthesia for patients undergoing transcatheter aortic valve implantation (TAVI) surgery has been controversial recently, especially with the popularization of TAVI in young and low-risk patients and reduced dependence on transesophageal echocardiography (TEE). Beyond general anesthesia (GA), there are more than one type of anesthetic methods such as regional anesthesia (RA), local anesthesia (LA), monitored anesthesia care (MAC), deep sedation (DS), conscious sedation (CS) et al. used on TAVI. The aim of this systematic review and meta-analysis was to evaluate the effects of general anesthesia on the prognosis of patients undergoing TAVI. Methods The Cochrane Library, PubMed, Embase, and Medline databases were searched from their inception to May 2025. Literature was selected according to the inclusion and exclusion criteria, and the meta-analysis was completed using RevMan 5.3. Results A total of eligible 38 literatures were enrolled, including 23,848 patients. The results of the meta-analysis showed that compared with the non-GA groups, the in-hospital mortality (RR = 1.99, 95%CI, 1.19–3.30, P = 0.008), incidence of postoperative pneumonia (RR = 2.39, 95%CI, 1.43–4.00, P = 0.0009), procedure time (MD = 20.22, 95%CI, 15.37–25.07, P < 0.00001), length of hospital stay (MD = 1.43, 95%CI, 1.10–1.76, P < 0.00001), and ICU stay (SMD = 1.91, 95%CI, 1.40–2.42, P < 0.00001) were all increased in the GA group. There were no significant differences between the groups in 30-day mortality (RR = 1.19, 95%CI, 0.97–1.47, P = 0.09), postoperative acute kidney injury (RR = 1.16, 95%CI, 0.90–1.50, P = 0.26), postoperative stroke (RR = 0.99, 95%CI, 0.80–1.22, P = 0.90), postoperative vascular complication (RR = 1.10, 95%CI, 0.92–1.33, P = 0.30), and postoperative myocardial infarction (RR = 1.12, 95%CI, 0.72–1.73, P = 0.61). Conclusion GA not only increases in-hospital mortality and the incidence of postoperative pulmonary infections in patients undergoing TAVI but also prolongs the length of hospitalization and ICU stay. However, GA did not increase the incidence of postoperative acute kidney injury, stroke, myocardial infarction, or vascular complications, nor did it increase the 30-day postoperative mortality rate and long-term quality of life in patients. The choice of anesthesia for TAVI should be evaluated according to the patient's condition and surgical approaches to minimize adverse complications and mortality. Further RCTs are required to verify the most likely anesthetic choices for TAVI.