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Interact Cardiovasc Thorac Surg. 2016 Jun;22(6):806-12. doi: 10.1093/icvts/ivw049. Epub 2016 Mar 14.

Results of surgical aortic valve replacement and transapical transcatheter aortic valve replacement in patients with previous coronary artery bypass grafting.

Author information

1
Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy francesco.onorati@ospedaleuniverona.it.
2
Division of Cardiac Surgery, University of Padua, Padova, Italy francesco.onorati@ospedaleuniverona.it.
3
Department of Cardiac Surgery, University of Oulu, Oulu, Finland.
4
Division of Cardiac Surgery, University of Torino, Turin, Italy.
5
Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Caserta, Italy.
6
Division of Cardiac Surgery, Monzino Hospital, Milan, Italy.
7
Cardiac Surgery Unit, Insubria University, Varese, Italy.
8
Clinica Montevergine, Avellino, Italy.
9
Cardiac Surgery Unit, Poliambulanza Foundation, Brescia, Italy.
10
Department of Cardiac Surgery, San Camillo Hospital, Rome, Italy.
11
Cardiovascular Center, Klinikum Nürnberg-Paracelsus Medical University, Nuremberg, Germany.
12
Division of Cardiac Surgery, Humanitas Gavazzeni Hospital, Bergamo, Italy.
13
IRCCS San Martino University Hospital, Genoa, Italy.
14
San Bortolo Hospital, Vicenza, Italy.
15
University of Pavia, Corvino San Quirico, Italy.
16
Policlinico Sant'Orsola Malpighi, Bologna, Italy.
17
Division of Cardiac Surgery, Clinica S. Maria, Bari, Italy.
18
Fondazione Monasterio, Massa, Italy.
19
Ordine Mauriziano Hospital, Turin, Italy.
20
San Raffaele University Hospital, Milan, Italy.
21
Cardiac Surgery Hesperia Hospital, Modena, Italy.
22
Division of Cardiac Surgery, Mestre, Italy.
23
Division of Cardiac Surgery, University of Parma, Parma, Italy.
24
S. Maria della Misericordia Hospital, Udine, Italy.
25
Division of Cardiac Surgery, Cuneo, Italy.
26
Division of Cardiac Surgery, AOU, Trieste, Italy.
27
Division of Cardiac Surgery, University of Padua, Padova, Italy.
28
Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy.

Abstract

OBJECTIVES:

To evaluate the results of aortic valve replacement through sternotomic approach in redo scenarios (RAVR) vs transapical transcatheter aortic valve replacement (TAVR), in patients in the eighth decade of life or older already undergone previous coronary artery bypass grafting (CABG).

METHODS:

One hundred and twenty-six patients undergoing RAVR were compared with 113 patients undergoing TaTAVR in terms of 30-day mortality and Valve Academic Research Consortium-2 outcomes. The two groups were also analysed after propensity-matching.

RESULTS:

TaTAVR patients demonstrated a higher incidence of 30-day mortality (P = 0.03), stroke (P = 0.04), major bleeding (P = 0.03), worse 'early safety' (P = 0.04) and lower permanent pacemaker implantation (P = 0.03). TaTAVR had higher follow-up hazard in all-cause mortality [hazard ratio (HR) 3.15, 95% confidence interval (CI) 1.28-6.62; P < 0.01] and cardiovascular mortality (HR 1.66, 95% CI 1.02-4.88; P = 0.04). Propensity-matched patients showed comparable 30-day outcome in terms of survival, major morbidity and early safety, with only a lower incidence of transfusions after TaTAVR (10.7% vs RAVR: 57.1%; P < 0.01). A trend towards lower Acute Kidney Injury Network Classification 2/3 (3.6% vs RAVR 21.4%; P = 0.05) and towards a lower freedom from all-cause mortality at follow-up (TaTAVR: 44.3 ± 21.3% vs RAVR: 86.6 ± 9.3%; P = .08) was demonstrated after TaTAVR, although cardiovascular mortality was comparable (TaTAVR: 86.5 ± 9.7% vs RAVR: 95.2 ± 4.6%; P = 0.52). Follow-up freedom from stroke, acute heart failure, reintervention on AVR and thrombo-embolisms were comparable (P = NS). EuroSCORE II (P = 0.02), perioperative stroke (P = 0.01) and length of hospitalization (P = 0.02) were the determinants of all-cause mortality at follow-up, whereas perioperative stroke (P = 0.03) and length of hospitalization (P = 0.04) impacted cardiovascular mortality at follow-up.

CONCLUSIONS:

Reported differences in mortality and morbidity after TaTAVR and RAVR reflect differences in baseline risk profiles. Given the lower trend for renal complications, patients at higher perioperative renal risk might be better served by TaTAVR.

KEYWORDS:

Aortic valve disease; Aortic valve replacement; Bioprosthesis malfunction; Redo; Transapical transcatheter aortic valve replacement

PMID:
26979656
PMCID:
PMC4986792
DOI:
10.1093/icvts/ivw049
[Indexed for MEDLINE]
Free PMC Article

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