Local anesthesia alone versus with sedation for transcatheter aortic valve implantation: a systematic review and...

As minimalist transcatheter aortic valve implantation (TAVI) programs continue to expand globally, significant practice variation persists in anesthetic strategy. This meta-analysis directly compares the safety and efficacy of local anesthesia alone (LA) versus local anesthesia with sedation (LAS) for TAVI.

We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception through September 2025. Primary outcomes included all-cause mortality, stroke, acute kidney injury (AKI), and ≥ moderate paravalvular regurgitation (PVR). Secondary outcomes encompassed procedural complications and efficiency metrics. Pooled risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CIs) were calculated using random- or fixed-effects models.

Seven studies (one randomized controlled trial, six observational) with 2,990 patients (LA: n = 1,229; LAS: n = 1,761) were included. We found no significant differences between LA and LAS in all-cause mortality (RR 0.67, 95% CI 0.35-1.29, p = 0.23), stroke (RR 0.77, 95% CI 0.37-1.62, p = 0.49), AKI (RR 0.67, 95% CI 0.26-1.73, p = 0.41), or PVR (RR 1.03, 95% CI 0.63-1.69, p = 0.91). Rates of vascular complications, pacemaker implantation, and major bleeding were also comparable. Procedural efficiency metrics, including procedure time (MD 2.76 min, 95% CI -2.70-8.21, p = 0.32) and hospital length of stay (MD -0.48 days, 95% CI -1.16-0.19, p = 0.16), did not differ significantly between groups.

In patients undergoing transfemoral TAVI, a minimalist approach using LA alone is non-inferior to LAS regarding short-term safety, efficacy, and procedural efficiency. These findings suggest that anesthetic strategy may be individualized based on patient-specific factors and operator experience while maintaining comparable clinical outcomes.

PROSPERO CRD420251146705.