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Hasan SM, Cikach F, Toth AJ, Blackstone EH, Krishnaswamy A, Kapadia S, Roselli EE, Gillinov AM, Svensson LG, Mick SL. Comparison of Outcomes and Discharge Location After Transcatheter vs. Surgical Aortic Valve Replacement With Prior Coronary Artery Bypass Grafting. STRUCTURAL HEART 2022. [DOI: 10.1016/j.shj.2022.100120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Kumar K, Chau T, Herman T, Samhan A, Morris CC, Lantz G, Chadderdon SM, Song HK, Zahr FE, Golwala H. Transcatheter Aortic Valve Implantation in Patients With Previous Coronary Artery Bypass Grafting. Am J Cardiol 2022; 172:166-168. [PMID: 35382928 DOI: 10.1016/j.amjcard.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 11/01/2022]
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Wang G, Li X, Zhang Z, Dong J. Comparison of rehabilitation outcomes for transcatheter versus surgical aortic valve replacement as redo procedure in patients with previous cardiac surgery: Evidence based on 11 observational studies. Medicine (Baltimore) 2021; 100:e27657. [PMID: 34766568 PMCID: PMC10545122 DOI: 10.1097/md.0000000000027657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/17/2021] [Accepted: 10/10/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Currently, the number of severe aortic stenosis (AS) patients with a history of prior cardiac surgery (PCS) has increased. Both transcatheter aortic valve replacement (TAVR) and traditional surgical aortic valve replacement (sAVR) are effective therapy for AS. However, PCS increases the risk of adverse outcomes in patients undergoing aortic valve replacement. Thus, this meta-analysis was designed to comparatively evaluate the impact of PCS on clinical outcomes between TAVR and sAVR. METHODS A systematic search of PubMed, Embase, Cochrane Library, and Web of Science up to February 1, 2021 was conducted for relevant studies that comparing TAVR and sAVR for severe AS patients with a history of PCS. The primary outcome was the non-inferiority of TAVR and sAVR in mortality. The secondary outcomes were the other clinical outcomes. Two reviewers assessed trial quality and extracted the data independently. All statistical analyses were performed using the standard statistical procedures provided in Review Manager 5.2. RESULTS A total of 11 studies including 8852 patients were identified. The pooled results indicated that there was no difference in 30-day, and 1-year all-cause mortality between TAVR and sAVR. No significant difference was also observed in total follow-up and cardiovascular mortality between TAVR and sAVR. However, subgroup analysis revealed significantly higher 1-year all-cause mortality (OR 1.92; 95% CI 1.05-3.52; P = .04) and total follow-up mortality (OR 2.28; 95% CI 1.09-4.77; P = .03) in TAVR than sAVR for patients with a history of coronary artery bypass graft, aortic valve replacement, and mitral valve reconstruction. In addition, TAVR experienced higher pacemaker implantation than sAVR. However, compared with sAVR, TAVR experienced shorter length of stay (MD -3.18 days; 95% CI -4.78 to -1.57 days) and procedural time (MD -172.01 minutes; 95% CI -251.15 to -92.88) respectively. TAVR also lead to much less bleeding than sAVR. CONCLUSIONS Our analysis shows that TAVR as a redo procedure was equal to sAVR in mortality for severe AS patients with PCS, especially coronary artery bypass graft. We agree the advantage of TAVR as a redo procedure for patients with a history of PCS. Patients receiving TAVR experienced rapid recovery, shorter operation time and less bleeding, without increasing short and long term mortality.
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Affiliation(s)
- Guobin Wang
- Rehabilitation Division Treatment Department, Wang Jing Hospital of China Academy of Chinese Medical Science, Beijing, China
| | - Xuefeng Li
- Department of Vascular Surgery, Wang Jing Hospital of China Academy of Chinese Medical Science, Beijing, China
| | - Zhaojie Zhang
- Department of Spinal Surgery, Wang Jing Hospital of China Academy of Chinese Medical Science, Beijing, China
| | - Jige Dong
- Rehabilitation Division Treatment Department, Wang Jing Hospital of China Academy of Chinese Medical Science, Beijing, China
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Li YM, Tsauo JY, Jia KY, Liao YB, Xia F, Zhao ZG, Chen M, Peng Y. Transcatheter and Surgical Aortic Valve Replacement in Patients With Previous Cardiac Surgery: A Meta-Analysis. Front Cardiovasc Med 2021; 7:612155. [PMID: 33644123 PMCID: PMC7902485 DOI: 10.3389/fcvm.2020.612155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 12/31/2020] [Indexed: 02/05/2023] Open
Abstract
Background: Many patients who have aortic stenosis and are transcatheter aortic valve replacement (TAVR) candidates have underwent prior cardiac surgery (PCS). The aim of this study was to provide a robust summary comparison between patients with PCS who underwent TAVR vs. surgical aortic valve replacement (SAVR). Methods: We conducted a systematic review and meta-analysis of all published articles on PubMed/Medline, Ovid, EMBASE, and Scopus from 2002 to 2019. Results: A total of 13 studies were finally included, yielding a total of 23,148 participants. There was no statistical difference with 30-day [OR: 1.02 (0.86–1.21)] or 1-year mortality [OR: 1.18 (0.86–1.61)] between the two groups. Subgroup analysis revealed that high-risk patients who underwent TAVR with the transapical approach were associated with increased risk of mortality [OR: 1.45 (1.00–2.11)]. However, those who underwent TAVR with endovascular approach had a comparable outcome with SAVR. Conclusions: Primary outcomes after endovascular TAVR were similar to those with SAVR and superior to transapical TAVR treatment group in patients with PCS.
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Affiliation(s)
- Yi-Ming Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jia-Yu Tsauo
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Kai-Yu Jia
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yan-Biao Liao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Fan Xia
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zheng-Gang Zhao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Peng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
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Kumar A, Sammour Y, Reginauld S, Sato K, Agrawal N, Lee JM, Meenakshisundaram C, Ramanan T, Kamioka N, Sawant AC, Mohananey D, Gleason PT, Devireddy C, Krishnaswamy A, Mavromatis K, Grubb K, Svensson LG, Tuzcu EM, Block PC, Iyer V, Babaliaros V, Kapadia S, Samady H. Adverse clinical outcomes in patients undergoing both PCI and TAVR: Analysis from a pooled multi-center registry. Catheter Cardiovasc Interv 2020; 97:529-539. [PMID: 32845036 DOI: 10.1002/ccd.29233] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/02/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND There is a paucity of data regarding the optimum timing of PCI in relation to TAVR. OBJECTIVE We compared the major adverse cardiovascular and cerebrovascular events (MACCE) rates among patients who underwent percutaneous coronary intervention (PCI) before transcatheter aortic valve replacement (TAVR) with those who received PCI with/after TAVR. METHODS In this multicenter study, we pooled all consecutive patients who underwent TAVR at three high volume centers. RESULTS Among 3,982 patients who underwent TAVR, 327 (8%) patients underwent PCI within 1 year before TAVR, 38 (1%) had PCI the same day as TAVR and 15 (0.5%) had PCI within 2 months after TAVR. Overall, among patients who received both PCI and TAVR (n = 380), history of previous CABG (HR:0.501; p = .001), higher BMI at TAVR (HR:0.970; p = .038), and statin therapy after TAVR (HR:0.660, p = .037) were independently associated with lower MACCE while warfarin therapy after TAVR was associated with a higher risk of MACCE (HR:1.779, p = .017). Patients who received PCI within 1 year before TAVR had similar baseline demographics, STS scores, clinical risk factors when compared to patients receiving PCI with/after TAVR. Both groups were similar in PCI (Syntax Score, ACC/AHA lesion class) and TAVR (valve types, access) related variables. There were no significant differences in terms of MACCE (log rank p = .550), all-cause mortality (log rank p = .433), strokes (log rank p = .153), and repeat PCI (log rank p = .054) in patients who underwent PCI with/after TAVR when compared to patients who received PCI before TAVR. CONCLUSION Among patients who underwent both PCI and TAVR, history of CABG, higher BMI, and statin therapy had lower, while those discharged on warfarin, had higher adverse event rates. Adverse events rates were similar regardless of timing of PCI.
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Affiliation(s)
- Arnav Kumar
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Yasser Sammour
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Shawn Reginauld
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Kimi Sato
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Nikhil Agrawal
- Department of Medicine Division of Cardiology, State University of New York at Buffalo, Buffalo, New York
| | - Joo Myung Lee
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
| | | | - Thammi Ramanan
- Department of Medicine Division of Cardiology, State University of New York at Buffalo, Buffalo, New York
| | - Norihiko Kamioka
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Abhishek C Sawant
- Department of Medicine Division of Cardiology, State University of New York at Buffalo, Buffalo, New York
| | | | - Patrick T Gleason
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Chandan Devireddy
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Amar Krishnaswamy
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Kreton Mavromatis
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Kendra Grubb
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Lars G Svensson
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - E Murat Tuzcu
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Peter C Block
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Vijay Iyer
- Department of Medicine Division of Cardiology, State University of New York at Buffalo, Buffalo, New York
| | - Vasilis Babaliaros
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Samir Kapadia
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Habib Samady
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
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Höllriegel R, Spindler A, Kiefer P, Woitek FJ, Leontyev S, Haussig S, Crusius L, Stachel G, Schlotter F, Hommel J, Borger MA, Thiele H, Holzhey D, Linke A, Mangner N. Outcome of patients with previous coronary artery bypass grafting and severe calcific aortic stenosis receiving transfemoral transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2019; 96:E196-E203. [PMID: 31714684 DOI: 10.1002/ccd.28515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 09/11/2019] [Accepted: 09/17/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To evaluate the impact of previous coronary artery bypass grafting (CABG) on early safety at 30 days and 1-year mortality in patients receiving transcatheter aortic valve replacement (TAVR). BACKGROUND The use of TAVR in patients with previous CABG suffering from severe aortic stenosis has increased in the last years. METHODS Consecutive TAVR patients were stratified according to previous CABG versus no previous cardiac surgery (control). All-cause 1-year mortality and early safety at 30 days were evaluated. RESULTS In the unmatched cohort and compared to control (n = 2,364), CABG (n = 260) were younger, more often male and suffered more often from comorbidities leading to an increased STS-score (p < .001). The rate of early safety events at 30 days was comparable between CABG and control (21.2% vs. 24.6%, p = .22) with a higher mortality in CABG (9.6% vs. 5.3%, p = .005). All-cause 1-year mortality was higher in CABG compared to controls (HR 1.51 [95%-CI 1.15-1.97], p = .003). Applying Cox regression analysis, both 30-day (HR 1.57 [95%-CI 0.97-2.53], p = .067) and all-cause 1-year mortality (HR 1.24 [95%-CI 0.91-1.70], p = .174) were not significantly different between groups. After propensity-score matching, the rate of early safety events at 30 days was lower in CABG compared to controls (21.6% vs. 31.7%, p = .02). Thirty-day (9.1% vs. 7.7%, p = .596) and all-cause 1-year mortality (24.0% vs. 23.1%, p = .520, HR 1.14 [95%-CI 0.77-1.69], p = .520) were not different between groups. CONCLUSION In patients receiving TAVR, previous CABG was not associated with an increase in periprocedural complications and all-cause 1-year mortality when adjusted for other comorbidities.
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Affiliation(s)
- Robert Höllriegel
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Aileen Spindler
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Philipp Kiefer
- Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Felix J Woitek
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Sergey Leontyev
- Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Stephan Haussig
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Lisa Crusius
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Georg Stachel
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Florian Schlotter
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Jennifer Hommel
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Michael A Borger
- Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - David Holzhey
- Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Axel Linke
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Norman Mangner
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
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Takagi H, Hari Y, Nakashima K, Kuno T, Ando T. A meta-analysis of ≥5-year mortality after transcatheter versus surgical aortic valve replacement. THE JOURNAL OF CARDIOVASCULAR SURGERY 2019; 61:107-116. [PMID: 31666501 DOI: 10.23736/s0021-9509.19.11030-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION It remains unclear whether long-term survival is superior following transcatheter aortic valve implantation (TAVI) than following surgical aortic valve replacement (SAVR). We performed a meta-analysis of mortality with ≥5-year follow-up in randomized controlled trials (RCTs) and propensity-score matched (PSM) studies of TAVI versus SAVR. EVIDENCE ACQUISITION MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched through March 2019. Eligible studies were RCTs or PSM studies of TAVI versus SAVR enrolling patients with severe aortic stenosis and reporting all-cause mortality with ≥5-year follow-up as an outcome. A hazard ratio of mortality for TAVI versus SAVR was extracted from each individual study. EVIDENCE SYNTHESIS Our search identified 3 RCTs and 7 PSM studies enrolling 5498 patients. A pooled analysis of all 10 studies demonstrated a statistically significant 38% increase in mortality with TAVI relative to SAVR. A subgroup meta-analysis showed no statistically significant difference between TAVI and AVR in RCTs and a statistically significant 68% increase with TAVI relative to SAVR in PSM studies. CONCLUSIONS On the basis of a meta-analysis of 7 PSM studies, TAVI is associated with greater all-cause mortality with ≥5-year follow-up than SAVR. However, another meta-analysis of 3 RCTs suggests no difference in mortality between TAVI and SAVR.
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Affiliation(s)
- Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan - .,Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan -
| | - Yosuke Hari
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.,Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kouki Nakashima
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.,Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Toshiki Kuno
- Department of Medicine, Mount Sinai Beth Israel Medical Center, New York, NY, USA
| | - Tomo Ando
- Department of Cardiology, Detroit Medical Center, Detroit, MI, USA
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Okoh AK, Sossou C, Kang N, Decker J, Dave D, Haik B, Chen C, Cohen M, Russo M. Left Ventricular Function Recovery After Transapical TAVR in Patients With Previous Coronary Artery Bypass Graft Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 14:405-411. [PMID: 31354084 DOI: 10.1177/1556984519864080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The transapical (TA) approach is an alternative access technique for transcatheter aortic valve replacement (TAVR) in patients with symptomatic aortic valve stenosis. The impact of prior coronary artery bypass graft (CABG) surgery and how it affects left ventricular function recovery is not well defined. METHODS Patients who had TAVR at a single center between June 2012 and December 2016 were reviewed. High-risk patients who underwent the procedure via a TA approach were divided into 2 groups based on their history of CABG surgery. Postoperative outcomes were compared between groups. CABG/TA-TAVR patients were subdivided into 2 per baseline left ventricular ejection fraction (LVEF) <50%. The changes in LVEF and valve function at follow-up (1 to 12 months) were analyzed using paired t-tests. RESULTS Of 923 cases in total, 183 (19.8%) were performed via a TA approach. The mean ± SD Society of Thoracic Surgeons risk score of TA patients was 10.2 ± 4.6. Forty-nine (27%) had a surgical history of CABG. Overall all-cause mortality rates at 30 days, 1 year, and 2 years were similar for both groups (P = 0.59, P = 0.64, P = 0.78). Subgrouping of CABG-TAVR patients (n = 49) identified 24 patients (49%) with LVEF ≥50% vs. 25 (51%) with LVEF <50%. At 1-year follow-up, significant improvements in LVEF (low LVEF group) and valve function for both groups were observed. LVEF ≥50% group (LVEF: ∆: -3%, P = 0.878; aortic valve area [AVA]: ∆: 1.3 cm2, P < 0.001; mean gradient: ∆: -38 mmHg, P < 0.001); LVEF <50% group (LVEF: ∆: 10%, P = 0.01; AVA: ∆: 1.3 cm2, P < 0.001; MG: ∆: -31 mmHg, P < 0.001). CONCLUSIONS TA-TAVR can be safely performed with acceptable postoperative outcomes in patients with a history of CABG surgery. In those with reduced EF, significant improvements in LV and valve functions are seen at 1-year follow-up.
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Affiliation(s)
- Alexis K Okoh
- Cardiovascular Research Institute, RWJ Barnabas Health Heart Centers, NBIMC, Newark, NJ, USA
| | - Christoph Sossou
- Cardiovascular Research Institute, RWJ Barnabas Health Heart Centers, NBIMC, Newark, NJ, USA
| | - Nathan Kang
- Cardiovascular Research Institute, RWJ Barnabas Health Heart Centers, NBIMC, Newark, NJ, USA
| | - Jonathan Decker
- Department of Surgery, Monmouth Medical Center, Long Branch, NJ, USA
| | - Devangi Dave
- Cardiovascular Research Institute, RWJ Barnabas Health Heart Centers, NBIMC, Newark, NJ, USA
| | - Bruce Haik
- Cardiovascular Research Institute, RWJ Barnabas Health Heart Centers, NBIMC, Newark, NJ, USA
| | - Chunguang Chen
- Cardiovascular Research Institute, RWJ Barnabas Health Heart Centers, NBIMC, Newark, NJ, USA
| | - Marc Cohen
- Cardiovascular Research Institute, RWJ Barnabas Health Heart Centers, NBIMC, Newark, NJ, USA
| | - Mark Russo
- Cardiovascular Research Institute, RWJ Barnabas Health Heart Centers, NBIMC, Newark, NJ, USA
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Gupta T, Khera S, Kolte D, Goel K, Kalra A, Villablanca PA, Aronow HD, Abbott JD, Fonarow GC, Taub CC, Kleiman NS, Weisz G, Inglessis I, Elmariah S, Rihal CS, Garcia MJ, Bhatt DL. Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Prior Coronary Artery Bypass Grafting: Trends in Utilization and Propensity-Matched Analysis of In-Hospital Outcomes. Circ Cardiovasc Interv 2019; 11:e006179. [PMID: 29643130 DOI: 10.1161/circinterventions.117.006179] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 02/19/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND A significant proportion of patients requiring aortic valve replacement (AVR) have undergone prior coronary artery bypass grafting (CABG). Reoperative heart surgery is associated with increased risk. Data on relative utilization and comparative outcomes of transcatheter (TAVR) versus surgical AVR (SAVR) in patients with prior CABG are limited. METHODS AND RESULTS We queried the 2012 to 2014 National Inpatient Sample databases to identify isolated AVR hospitalizations in adults with prior CABG. In-hospital outcomes of TAVR versus SAVR were compared using propensity-matched analysis. Of 147 395 AVRs, 15 055 (10.2%) were in patients with prior CABG. The number of TAVRs in patients with prior CABG increased from 1615 in 2012 to 4400 in 2014, whereas the number of SAVRs decreased from 2285 to 1895 (Ptrend<0.001). There were 3880 records in each group in the matched cohort. Compared with SAVR, TAVR was associated with similar in-hospital mortality (2.3% versus 2.4%; P=0.71) but lower incidence of myocardial infarction (1.5% versus 3.4%; P<0.001), stroke (1.4% versus 2.7%; P<0.001), bleeding complications (10.6% versus 24.6%; P<0.001), and acute kidney injury (16.2% versus 19.3%; P<0.001). Requirement for prior permanent pacemaker was higher in the TAVR cohort, whereas the incidence of vascular complications and acute kidney injury requiring dialysis was similar in the 2 groups. Average length of stay was shorter in patients undergoing TAVR. CONCLUSIONS TAVR is being increasingly used as the preferred modality of AVR in patients with prior CABG. Compared with SAVR, TAVR is associated with similar in-hospital mortality but lower rates of in-hospital complications in this important subset of patients.
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Affiliation(s)
- Tanush Gupta
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., C.C.T., G.W., M.J.G.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K., I.I., S.E.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.,); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Division of Cardiovascular Medicine, Case Western Reserve University School of Medicine, Cleveland, OH (A.K.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, TX (N.S.K.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Sahil Khera
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., C.C.T., G.W., M.J.G.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K., I.I., S.E.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.,); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Division of Cardiovascular Medicine, Case Western Reserve University School of Medicine, Cleveland, OH (A.K.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, TX (N.S.K.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Dhaval Kolte
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., C.C.T., G.W., M.J.G.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K., I.I., S.E.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.,); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Division of Cardiovascular Medicine, Case Western Reserve University School of Medicine, Cleveland, OH (A.K.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, TX (N.S.K.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Kashish Goel
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., C.C.T., G.W., M.J.G.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K., I.I., S.E.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.,); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Division of Cardiovascular Medicine, Case Western Reserve University School of Medicine, Cleveland, OH (A.K.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, TX (N.S.K.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Ankur Kalra
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., C.C.T., G.W., M.J.G.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K., I.I., S.E.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.,); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Division of Cardiovascular Medicine, Case Western Reserve University School of Medicine, Cleveland, OH (A.K.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, TX (N.S.K.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Pedro A Villablanca
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., C.C.T., G.W., M.J.G.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K., I.I., S.E.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.,); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Division of Cardiovascular Medicine, Case Western Reserve University School of Medicine, Cleveland, OH (A.K.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, TX (N.S.K.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Herbert D Aronow
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., C.C.T., G.W., M.J.G.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K., I.I., S.E.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.,); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Division of Cardiovascular Medicine, Case Western Reserve University School of Medicine, Cleveland, OH (A.K.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, TX (N.S.K.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - J Dawn Abbott
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., C.C.T., G.W., M.J.G.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K., I.I., S.E.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.,); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Division of Cardiovascular Medicine, Case Western Reserve University School of Medicine, Cleveland, OH (A.K.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, TX (N.S.K.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Gregg C Fonarow
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., C.C.T., G.W., M.J.G.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K., I.I., S.E.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.,); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Division of Cardiovascular Medicine, Case Western Reserve University School of Medicine, Cleveland, OH (A.K.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, TX (N.S.K.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Cynthia C Taub
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., C.C.T., G.W., M.J.G.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K., I.I., S.E.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.,); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Division of Cardiovascular Medicine, Case Western Reserve University School of Medicine, Cleveland, OH (A.K.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, TX (N.S.K.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Neal S Kleiman
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., C.C.T., G.W., M.J.G.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K., I.I., S.E.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.,); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Division of Cardiovascular Medicine, Case Western Reserve University School of Medicine, Cleveland, OH (A.K.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, TX (N.S.K.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Giora Weisz
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., C.C.T., G.W., M.J.G.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K., I.I., S.E.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.,); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Division of Cardiovascular Medicine, Case Western Reserve University School of Medicine, Cleveland, OH (A.K.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, TX (N.S.K.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Ignacio Inglessis
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., C.C.T., G.W., M.J.G.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K., I.I., S.E.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.,); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Division of Cardiovascular Medicine, Case Western Reserve University School of Medicine, Cleveland, OH (A.K.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, TX (N.S.K.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Sammy Elmariah
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., C.C.T., G.W., M.J.G.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K., I.I., S.E.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.,); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Division of Cardiovascular Medicine, Case Western Reserve University School of Medicine, Cleveland, OH (A.K.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, TX (N.S.K.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Charanjit S Rihal
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., C.C.T., G.W., M.J.G.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K., I.I., S.E.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.,); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Division of Cardiovascular Medicine, Case Western Reserve University School of Medicine, Cleveland, OH (A.K.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, TX (N.S.K.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Mario J Garcia
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., C.C.T., G.W., M.J.G.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K., I.I., S.E.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.,); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Division of Cardiovascular Medicine, Case Western Reserve University School of Medicine, Cleveland, OH (A.K.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, TX (N.S.K.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Deepak L Bhatt
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., C.C.T., G.W., M.J.G.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K., I.I., S.E.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.,); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Division of Cardiovascular Medicine, Case Western Reserve University School of Medicine, Cleveland, OH (A.K.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, TX (N.S.K.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.).
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10
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Yanagawa B, An KR, Ouzounian M, Gaudino M, Puskas JD, Asaoka N, Verma S, Friedrich JO. Management of Less-Than-Severe Aortic Stenosis During Coronary Bypass: A Systematic Review and Meta-Analysis. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 14:291-298. [PMID: 31185776 DOI: 10.1177/1556984519849639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The management of concomitant mild-to-moderate aortic stenosis (AS) at the time of coronary artery bypass graft (CABG) is controversial. Here we perform a systematic review and meta-analysis of CABG and aortic valve replacement (AVR) versus CABG alone in patients with mild-moderate AS. METHODS We searched MEDLINE and EMBASE databases until July 2018 for studies comparing CABG & AVR versus CABG in patients with mild-moderate AS undergoing coronary bypass. Data were extracted by 2 independent investigators. The main outcomes were operative mortality, long-term survival, and reintervention for AS. RESULTS There were 6 unmatched retrospective observational studies with 1,172 patients (median follow-up 4.7 [interquartile range: 4.3 to 5.3] years). Patients undergoing CABG & AVR had less severe coronary artery disease. There were no differences in operative mortality (relative risk [RR]: 1.07; 95% CI, 0.59 to 1.94; P = 0.8). CABG & AVR was associated with greater incidence of stroke, bleeding, renal failure, and mediastinitis. At median follow-up of 5 years, there was no difference in long-term mortality (incidence rate ratio [IRR]:1.44; 95% CI, 0.83 to 2.51; P = 0.19), but CABG & AVR was associated with 73% lower risk of reoperation for AS (n = 13/485 versus n = 71/702; IRR: 0.27; 95% CI, 0.14 to 0.51; P < 0.001). CONCLUSIONS In patients undergoing CABG with mild-moderate AS, combining AVR with CABG was associated with no difference in operative mortality but with increased risk of stroke, bleeding, renal failure, and mediastinitis. Long-term mortality was not different, but a risk of reoperation for AS at 5 years was 73% lower. Given the increasingly wide availability and safety of transcatheter aortic valve replacement (TAVR), one may consider a conservative approach toward concomitant mild-moderate AS.
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Affiliation(s)
- Bobby Yanagawa
- 1 Divisions of Cardiac Surgery, St Michael's Hospital, University of Toronto, Ontario, Canada
| | - Kevin R An
- 1 Divisions of Cardiac Surgery, St Michael's Hospital, University of Toronto, Ontario, Canada
| | - Maral Ouzounian
- 2 Division of Cardiac Surgery, Toronto General Hospital, University of Toronto, Ontario, Canada
| | - Mario Gaudino
- 3 Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - John D Puskas
- 4 Department of Cardiovascular Surgery, Mount Sinai Heart at Mount Sinai Saint Luke's, New York, NY, USA
| | - Nozomi Asaoka
- 1 Divisions of Cardiac Surgery, St Michael's Hospital, University of Toronto, Ontario, Canada
| | - Subodh Verma
- 1 Divisions of Cardiac Surgery, St Michael's Hospital, University of Toronto, Ontario, Canada
| | - Jan O Friedrich
- 5 Divisions of Critical Care, St Michael's Hospital, University of Toronto, Ontario, Canada
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11
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Orlov OI, Kaleda VI, Shah VN, Nguyen C, Orlov CP, Sicouri S, Takebe M, Goldman SM, Plestis KA. Ministernotomy aortic valve surgery in patients with prior patent mammary artery grafts after coronary artery bypass grafting. Eur J Cardiothorac Surg 2019; 55:1174-1179. [PMID: 30649235 DOI: 10.1093/ejcts/ezy442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/19/2018] [Accepted: 11/24/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Patients with patent internal thoracic artery (ITA) grafts after prior coronary artery bypass grafting surgery who require aortic valve replacement (AVR) pose unique technical challenges for safe and optimal myocardial protection. The purpose of this study is to review our short- and long-term outcomes with redo minimally invasive AVR in patients with patent in situ ITA grafts. METHODS From 2008 to 2016, 48 patients with at least 1 patent in situ mammary artery graft underwent minimally invasive AVR. Preoperative computed tomography was performed in all patients to evaluate the relationship of patent grafts to the sternum. Retrograde coronary sinus and pulmonary vent catheters were placed via the right internal jugular vein. The in situ ITA grafts were not clamped during AVR. Transverse aortotomy, taking care to avoid the grafts arising from the aorta, was performed to expose the aortic valve. RESULTS The median age of the patients was 78 years [Quartile 1 (Q1)-Quartile 3 (Q3): 71-81]. Thirty-nine (81%) patients were men, and 46 (96%) patients had aortic stenosis. The median cardiopulmonary bypass and cross-clamp times were 124 (Q1-Q3: 108-164) and 92 (Q1-Q3: 83-116) min, respectively. Moderate hypothermia at 28-30°C was used in all patients. Most patients received cold blood cardioplegia with antegrade induction and continuous retrograde delivery. Four patients received only retrograde delivery due to some degree of aortic insufficiency. Thirty-day mortality was 4% (2 of 48 patients). There was no conversion to full sternotomy, and no reoperations were performed for postoperative bleeding or sternal wound infection. Excluding the 2 patients who died in the hospital, the median postoperative length of stay was 7 days (Q1-Q3: 5-8). Overall survival at 1, 5 and 10 years was 94%, 87% and 44%, respectively. CONCLUSIONS Percutaneous retrograde cardioplegia combined with antegrade cardioplegia and moderate hypothermia, without interruption of ITA flow, is a safe and reliable strategy in patients with patent ITA grafts undergoing aortic valve replacement. This strategy combined with a minimally invasive approach may reduce surgical trauma, and is a safe and effective technique in these challenging patients.
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Affiliation(s)
- Oleg I Orlov
- Department of Cardiothoracic Surgery, Lankenau Medical Center, Wynnewood, PA, USA.,Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA, USA
| | - Vasily I Kaleda
- Department of Cardiac Surgery, Central Clinical Hospital, Moscow, Russian Federation
| | - Vishal N Shah
- Department of Cardiothoracic Surgery, Lankenau Medical Center, Wynnewood, PA, USA.,Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA, USA
| | - Catherine Nguyen
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA, USA
| | - Cinthia P Orlov
- Department of Cardiothoracic Surgery, Lankenau Medical Center, Wynnewood, PA, USA.,Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA, USA
| | - Serge Sicouri
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA, USA
| | - Manabu Takebe
- Department of Cardiothoracic Surgery, Lankenau Medical Center, Wynnewood, PA, USA
| | - Scott M Goldman
- Department of Cardiothoracic Surgery, Lankenau Medical Center, Wynnewood, PA, USA
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12
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Gössl M, Ahmed A. Transcatheter Aortic Valve Replacement Versus Surgical Aortic Valve Replacement: A Prior Sternotomy Is Not the Problem. JACC Cardiovasc Interv 2018; 11:2217-2219. [PMID: 30409279 DOI: 10.1016/j.jcin.2018.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 08/14/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Mario Gössl
- Valve Science Center, Minneapolis Heart Institute and Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota.
| | - Aisha Ahmed
- Valve Science Center, Minneapolis Heart Institute and Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
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13
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Nalluri N, Atti V, Patel NJ, Kumar V, Arora S, Nalluri S, Nelluri BK, Maniatis GA, Kandov R, Kliger C. Propensity matched comparison of in-hospital outcomes of TAVR vs. SAVR in patients with previous history of CABG: Insights from the Nationwide inpatient sample. Catheter Cardiovasc Interv 2018; 92:1417-1426. [PMID: 30079611 DOI: 10.1002/ccd.27708] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/03/2018] [Accepted: 05/30/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND The incidence of patients with previous history of coronary artery bypass grafting (CABG) presenting for aortic valvular replacement has been consistently on the rise. Repeat sternotomy for surgical aortic valve replacement (SAVR) carries an inherent risk of morbidity and mortality when compared to Transcatheter aortic valve replacement (TAVR). METHODS The Nationwide inpatient sample (NIS) from 2012 to 2014 was queried using the International Classification of Diseases-Ninth edition, Clinical Modification (ICD-9-CM) codes to identify all patients ≥ 18 years with prior CABG who underwent TAVR (35.05 and 35.06) or SAVR (35.21 and 35.22). Propensity score matching (1:1) was performed and in-hospital outcomes were compared between matched cohorts. RESULTS From 2012 to 2014, there was progressive increase in the annual number of TAVR procedures from 1485 to 4020, with a decrease in patients undergoing SAVR from 2330 to 1955 (Ptrend < 0.0001) in the above population. There was no significant difference in in-hospital mortality rates. Compared to SAVR, TAVR was associated with lower risk of stroke (1.2% vs. 3.3%, P = 0.009), AKI (12.9% vs. 21.3%, P < 0.0001), myocardial infarction (0.9% vs. 2.7%, P = 0.01) and major bleeding (9.1% vs. 25.1%, P < 0.0001). TAVR was associated with higher risk of pacemaker implants (9.6% vs. 4.9%, P = 0.001) and trend toward lower risk of vascular complications (2.3% vs. 4.1%, P = 0.05). CONCLUSION In this large cohort of patients with previous CABG, there is no significant difference in in-hospital mortality between TAVR and SAVR. TAVR was associated with lower risk of in-hospital outcomes.
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Affiliation(s)
- Nikhil Nalluri
- Department of Cardiology, Staten Island University Hospital, New York City, New York
| | - Varunsiri Atti
- Department of Internal medicine, Michigan State University-Sparrow Hospital, East Lansing, Michigan
| | - Nileshkumar J Patel
- Department of Cardiology, University of Miami-Jackson Memorial Hospital, Miami, Florida
| | - Varun Kumar
- Department of Cardiology, Mount Sinai St Luke's Roosevelt hospital, New York City, New York
| | - Shilpkumar Arora
- Department of Internal medicine, Guthrie Robert Packer Hospital, Sayre, Pennsylvania
| | | | | | - Gregory A Maniatis
- Department of Cardiology, Staten Island University Hospital, New York City, New York
| | - Ruben Kandov
- Department of Cardiology, Staten Island University Hospital, New York City, New York
| | - Chad Kliger
- Department of Cardiology, Structural Heart Disease Lenox Hill Hospital, New York City, New York
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14
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Transcatheter versus Surgical Aortic Valve Replacement after Previous Cardiac Surgery: A Systematic Review and Meta-Analysis. Cardiol Res Pract 2018; 2018:4615043. [PMID: 29850227 PMCID: PMC5907513 DOI: 10.1155/2018/4615043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 12/27/2017] [Accepted: 01/23/2018] [Indexed: 12/24/2022] Open
Abstract
Aim Aortic valve replacement (AVR) in patients with prior cardiac surgery might be challenging. Transcatheter aortic valve replacement (TAVR) offers a promising alternative in such patients. We therefore aimed at comparing the outcomes of patients with aortic valve diseases undergoing TAVR versus those undergoing surgical AVR (SAVR) after previous cardiac surgery. Methods and Results MEDLINE, EMBASE, and the Cochrane Central Register were searched. Seven relevant studies were identified, published between 01/2011 and 12/2015, enrolling a total of 1148 patients with prior cardiac surgery (97.6% prior CABG): 49.2% underwent TAVR, whereas 50.8% underwent SAVR. Incidence of stroke (3.8 versus 7.9%, p=0.04) and major bleeding (8.3 versus 15.3%, p=0.04) was significantly lower in the TAVR group. Incidence of mild/severe paravalvular leakage (14.4/10.9 versus 0%, p < 0.0001) and pacemaker implantation (11.3 versus 3.9%, p=0.01) was significantly higher in the TAVR group. There were no significant differences in the incidence of acute kidney injury (9.7 versus 8.7%, p=0.99), major adverse cardiovascular events (8.7 versus 12.3%, p=0.21), 30-day mortality (5.1 versus 5.5%, p=0.7), or 1-year mortality (11.6 versus 11.8%, p=0.97) between the TAVR and SAVR group. Conclusions TAVR as a redo procedure offers a safe alternative for patients presenting with aortic valve diseases after previous cardiac surgery especially those with prior CABG.
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15
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Klinkhammer B. Transcatheter Aortic Valve Replacement After Coronary Artery Bypass Graft Is Associated With Increased Pacemaker Implantation but Not Reduced Overall Survival. Cardiol Res 2018; 9:40-45. [PMID: 29479385 PMCID: PMC5819628 DOI: 10.14740/cr684w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 01/29/2018] [Indexed: 12/26/2022] Open
Abstract
Background A history of coronary artery bypass graft (CABG) is a common compelling indication for transcatheter aortic valve replacement (TAVR). However, there is little data on how these patients compare to other TAVR patients. In this study, the short and long-term outcomes of these TAVR patients after CABG are defined. Methods A retrospective chart review case-control study of 337 consecutive patients who underwent a TAVR for severe aortic stenosis at Sanford Health in Fargo ND was performed to determine if a history of prior CABG was associated with worse outcomes after TAVR as compared to a TAVR cohort without a history of CABG. Results Despite higher predicted surgical risk, patients with a history of CABG had no significant difference overall survival at 1 month (98% vs. 93%, P = 0.112), 6 months (94% vs. 87%, P = 0.094), 1 year (85% vs. 77%, P = 0.206) or 2 years (70% vs. 57%, P = 0.135) post-TAVR. However, a history of CABG was associated with an increase in post-TAVR permanent pacemaker (PPM) implantation (15% vs. 6%, P = 0.015). Conclusions This study gives evidence to suggest that patients with a history of prior CABG do not have any difference in overall survival as other TAVR patients, despite higher predicted surgical risk and differences in preprocedural comorbidities. Our study also confirms the safety of TAVR in this specific population in lower volume centers.
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Affiliation(s)
- Brent Klinkhammer
- University of Nebraska Medical Center, 982055 Nebraska Medical Center, Omaha, NE 68198-2055, USA.
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16
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Takagi H, Mitta S, Ando T. Long-term survival after transcatheter versus surgical aortic valve replacement for aortic stenosis: A meta-analysis of observational comparative studies with a propensity-score analysis. Catheter Cardiovasc Interv 2018; 92:419-430. [DOI: 10.1002/ccd.27521] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 12/24/2017] [Accepted: 01/08/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Hisato Takagi
- Department of Cardiovascular Surgery; Shizuoka Medical Center; Shizuoka Japan
| | - Shohei Mitta
- Department of Cardiovascular Surgery; Shizuoka Medical Center; Shizuoka Japan
| | - Tomo Ando
- Department of Cardiology; Detroit Medical Center; Detroit Michigan
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Yammine M, Ramirez-Del Val F, Ejiofor JI, Neely RC, Shi D, McGurk S, Aranki SF, Kaneko T, Shekar PS. Parsimonious assessment for reoperative aortic valve replacement; the deterrent effect of low left ventricular ejection fraction and renal impairment. Ann Cardiothorac Surg 2017; 6:484-492. [PMID: 29062743 DOI: 10.21037/acs.2017.08.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Patient comorbidities play a pivotal role in the surgical outcomes of reoperative aortic valve replacement (re-AVR). Low left ventricular ejection fraction (LVEF) and renal insufficiency (Cr >2 mg/dL) are known independent surgical risk factors. Improved preoperative risk assessment can help determine the best therapeutic approach. We hypothesize that re-AVR patients with low LVEF and concomitant renal insufficiency have a prohibitive surgical risk and may benefit from transcatheter AVR (TAVR). METHODS From January 2002 to March 2013, we reviewed 232 patients who underwent isolated re-AVR. Patients older than 80 years were excluded to adjust for unobserved frailty. We identified 37 patients with a ≤35% LVEF (low ejection fraction group-LEF) and 195 patients with >35% LVEF (High ejection fraction group-HEF). RESULTS The mean age was 68.4±11.5 years and there were more females (86.5% versus 64.1%, P=0.007) in the LEF group. The prevalence of renal insufficiency was higher in LEF patients (27% versus 5.6%, P=0.001). Higher operative mortality (13.5% versus 3.1%, P=0.018) was observed in the LEF group. Stroke rates were similar in both groups (8.1% versus 4.1%, P=0.39). Unadjusted cumulative survival was significantly lower in LEF patients (6.6 years, 95% CI: 5.2-8.0, versus 9.7 years, 95% CI: 8.9-10.4, P=0.024). In patients without renal insufficiency, LEF and HEF had similar survival (8.3 years, 95% CI: 7.1-9.5, versus 9.9 years, 95% CI: 9.1-10.6, P=0.90). Contrarily, in patients with renal insufficiency, LEF led to a significantly lower survival (1.1 years, 95% CI: 0.1-2.0, versus 4.8 years, 95% CI: 2.2-7.3, P=0.050). Adjusted survival analysis revealed elevations in baseline creatinine (HR =4.28, P<0.001) and LEF (HR =5.33, P=0.041) as significant predictors of long-term survival, with a significant interaction between these comorbidities (HR =7.28, P<0.001). CONCLUSIONS In re-AVR patients, low LVEF (≤35%) is associated with increased operative mortality. Concomitant renal insufficiency in these patients results in a prohibitively low cumulative survival. These reoperative surgical outcomes should warrant expanding the role of TAVR for reoperative patients with LEF and renal impairment.
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Affiliation(s)
- Maroun Yammine
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Fernando Ramirez-Del Val
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Julius I Ejiofor
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert C Neely
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Diana Shi
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Siobhan McGurk
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sary F Aranki
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Prem S Shekar
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Villablanca PA, Mathew V, Thourani VH, Rodés-Cabau J, Bangalore S, Makkiya M, Vlismas P, Briceno DF, Slovut DP, Taub CC, McCarthy PM, Augoustides JG, Ramakrishna H. A meta-analysis and meta-regression of long-term outcomes of transcatheter versus surgical aortic valve replacement for severe aortic stenosis. Int J Cardiol 2016; 225:234-243. [DOI: 10.1016/j.ijcard.2016.10.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 08/04/2016] [Accepted: 10/04/2016] [Indexed: 10/20/2022]
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Is There a Place for Surgical Aortic Valve Replacement in Patients With Aortic Stenosis and Previous Coronary Bypass Grafting? JACC Cardiovasc Interv 2016; 9:2144-2146. [DOI: 10.1016/j.jcin.2016.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 09/07/2016] [Accepted: 09/07/2016] [Indexed: 11/19/2022]
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Foroutan F, Guyatt GH, O'Brien K, Bain E, Stein M, Bhagra S, Sit D, Kamran R, Chang Y, Devji T, Mir H, Manja V, Schofield T, Siemieniuk RA, Agoritsas T, Bagur R, Otto CM, Vandvik PO. Prognosis after surgical replacement with a bioprosthetic aortic valve in patients with severe symptomatic aortic stenosis: systematic review of observational studies. BMJ 2016; 354:i5065. [PMID: 27683072 PMCID: PMC5040922 DOI: 10.1136/bmj.i5065] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To determine the frequency of survival, stroke, atrial fibrillation, structural valve deterioration, and length of hospital stay after surgical replacement of an aortic valve (SAVR) with a bioprosthetic valve in patients with severe symptomatic aortic stenosis. DESIGN Systematic review and meta-analysis of observational studies. DATA SOURCES Medline, Embase, PubMed (non-Medline records only), Cochrane Database of Systematic Reviews, and Cochrane CENTRAL from 2002 to June 2016. STUDY SELECTION Eligible observational studies followed patients after SAVR with a bioprosthetic valve for at least two years. METHODS Reviewers, independently and in duplicate, evaluated study eligibility, extracted data, and assessed risk of bias for patient important outcomes. We used the GRADE system to quantify absolute effects and quality of evidence. Published survival curves provided data for survival and freedom from structural valve deterioration, and random effect models provided the framework for estimates of pooled incidence rates of stroke, atrial fibrillation, and length of hospital stay. RESULTS In patients undergoing SAVR with a bioprosthetic valve, median survival was 16 years in those aged 65 or less, 12 years in those aged 65 to 75, seven years in those aged 75 to 85, and six years in those aged more than 85. The incidence rate of stroke was 0.25 per 100 patient years (95% confidence interval 0.06 to 0.54) and atrial fibrillation 2.90 per 100 patient years (1.78 to 4.79). Post-SAVR, freedom from structural valve deterioration was 94.0% at 10 years, 81.7% at 15 years, and 52% at 20 years, and mean length of hospital stay was 12 days (95% confidence interval 9 to 15). CONCLUSION Patients with severe symptomatic aortic stenosis undergoing SAVR with a bioprosthetic valve can expect only slightly lower survival than those without aortic stenosis, and a low incidence of stroke and, up to 10 years, of structural valve deterioration. The rate of deterioration increases rapidly after 10 years, and particularly after 15 years.
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Affiliation(s)
- Farid Foroutan
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada L8S 4L8 Heart Failure/Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Gordon H Guyatt
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada L8S 4L8
| | - Kathleen O'Brien
- Heart Failure/Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Eva Bain
- Heart Failure/Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Madeleine Stein
- Heart Failure/Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Sai Bhagra
- Heart Failure/Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Daegan Sit
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada L8S 4L8
| | - Rakhshan Kamran
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada L8S 4L8
| | - Yaping Chang
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada L8S 4L8
| | - Tahira Devji
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada L8S 4L8
| | - Hassan Mir
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada L8S 4L8
| | - Veena Manja
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada L8S 4L8 Department of Internal Medicine, State University of New York at Buffalo, Buffalo, USA VA WNY Health Care System at Buffalo, Department of Veterans Affairs, USA
| | - Toni Schofield
- Heart Failure/Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Reed A Siemieniuk
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada L8S 4L8 Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Thomas Agoritsas
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada L8S 4L8 Division of General Internal Medicine, and Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Rodrigo Bagur
- Division of Cardiology, London Health Sciences Centre and Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada N6A 5W9
| | - Catherine M Otto
- Division of Cardiology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Per O Vandvik
- Department of Internal Medicine, Innlandet Hospital Trust-division Gjøvik, Norway Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway
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Ando T, Briasoulis A, Holmes AA, Afonso L, Schreiber T, Kondur A. Transcatheter aortic valve replacement versus surgical aortic valve replacement in patients with previous coronary artery bypass surgery: A systematic review and meta-analysis. Int J Cardiol 2016; 215:14-9. [PMID: 27104920 DOI: 10.1016/j.ijcard.2016.04.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 04/10/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Patients with severe aortic stenosis (AS) and previous coronary artery bypass graft (CABG) surgery have increased risk for aortic valve replacement. Whether surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) offers better outcomes in this population is unclear. We aimed to assess outcomes of TAVR and SAVR in patients with previous CABG. METHODS A systematic literature search of Medline, EMBASE and Cochrane library was conducted. Studies that reported clinical outcomes (perioperative or mid-term all-cause-mortality, cardiovascular mortality, pacemaker implantation, hospital duration and stroke) were included. Random-effect modeling was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Five cohort studies including a total of 872 patients (423 in TAVR, 449 in SAVR) were analyzed. STS scores were comparable between the two groups. No difference in all-cause-mortality, cardiovascular mortality and stroke at 30days, 1year and total follow-up period was seen between the two groups. TAVR patients had higher pacemaker implantation rates (OR 3.41, 95% CI 1.66-6.38, p<0.001, I(2)=21%) and shorter hospital stay (-2.63days, 95% CI -5.20 to -0.04, p=0.05, I(2)=43%). CONCLUSIONS Patients with previous CABG who underwent TAVR had similar perioperative and long-term survival while experiencing more pacemaker implantations and shorter hospital stay compared to those who had SAVR making TAVR a safe and efficacious alternative to SAVR.
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Affiliation(s)
- Tomo Ando
- Wayne State University, Detroit Medical Center, Division of Cardiology, Detroit, MI 48226, USA
| | - Alexandros Briasoulis
- Wayne State University, Detroit Medical Center, Division of Cardiology, Detroit, MI 48226, USA.
| | - Anthony A Holmes
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA
| | - Luis Afonso
- Wayne State University, Detroit Medical Center, Division of Cardiology, Detroit, MI 48226, USA
| | - Theodore Schreiber
- Wayne State University, Detroit Medical Center, Division of Cardiology, Detroit, MI 48226, USA
| | - Ashok Kondur
- Wayne State University, Detroit Medical Center, Division of Cardiology, Detroit, MI 48226, USA
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Onorati F, D'Onofrio A, Biancari F, Salizzoni S, De Feo M, Agrifoglio M, Mariscalco G, Lucchetti V, Messina A, Musumeci F, Santarpino G, Esposito G, Santini F, Magagna P, Beghi C, Aiello M, Ratta ED, Savini C, Troise G, Cassese M, Fischlein T, Glauber M, Passerone G, Punta G, Juvonen T, Alfieri O, Gabbieri D, Mangino D, Agostinelli A, Livi U, Di Gregorio O, Minati A, Rinaldi M, Gerosa G, Faggian G. Results of surgical aortic valve replacement and transapical transcatheter aortic valve replacement in patients with previous coronary artery bypass grafting. Interact Cardiovasc Thorac Surg 2016; 22:806-12. [PMID: 26979656 DOI: 10.1093/icvts/ivw049] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 01/18/2016] [Indexed: 01/04/2023] Open
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.
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Affiliation(s)
- Francesco Onorati
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
| | | | - Fausto Biancari
- Department of Cardiac Surgery, University of Oulu, Oulu, Finland
| | | | - Marisa De Feo
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Caserta, Italy
| | | | | | | | - Antonio Messina
- Cardiac Surgery Unit, Poliambulanza Foundation, Brescia, Italy
| | | | - Giuseppe Santarpino
- Cardiovascular Center, Klinikum Nürnberg-Paracelsus Medical University, Nuremberg, Germany
| | - Giampiero Esposito
- Division of Cardiac Surgery, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | | | | | - Cesare Beghi
- Cardiac Surgery Unit, Insubria University, Varese, Italy
| | | | - Ester Dalla Ratta
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Caserta, Italy
| | - Carlo Savini
- Policlinico Sant'Orsola Malpighi, Bologna, Italy
| | - Giovanni Troise
- Cardiac Surgery Unit, Poliambulanza Foundation, Brescia, Italy
| | - Mauro Cassese
- Division of Cardiac Surgery, Clinica S. Maria, Bari, Italy
| | - Theodor Fischlein
- Cardiovascular Center, Klinikum Nürnberg-Paracelsus Medical University, Nuremberg, Germany
| | | | | | | | - Tatu Juvonen
- Department of Cardiac Surgery, University of Oulu, Oulu, Finland
| | | | | | | | | | - Ugolino Livi
- S. Maria della Misericordia Hospital, Udine, Italy
| | | | | | - Mauro Rinaldi
- Division of Cardiac Surgery, University of Torino, Turin, Italy
| | - Gino Gerosa
- Division of Cardiac Surgery, University of Padua, Padova, Italy
| | - Giuseppe Faggian
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
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Conte JV, Gleason TG, Resar JR, Adams DH, Deeb GM, Popma JJ, Hughes GC, Zorn GL, Reardon MJ. Transcatheter or Surgical Aortic Valve Replacement in Patients With Prior Coronary Artery Bypass Grafting. Ann Thorac Surg 2015; 101:72-9; discussion 79. [PMID: 26433523 DOI: 10.1016/j.athoracsur.2015.06.067] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 05/27/2015] [Accepted: 06/22/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) are treatment options for aortic stenosis in patients with prior coronary artery bypass graft surgery. We assessed the major clinical outcomes of such patients enrolled in the CoreValve High Risk (CHR) study. METHODS Of the 795 CHR study patients, 226 had prior coronary artery bypass graft surgery; 115 underwent TAVR and 111 underwent SAVR. The primary endpoint was a comparison of all-cause mortality at 1 year. Important secondary clinical endpoints were assessed. RESULTS At 1 year, all-cause mortality was 9.6% for TAVR versus 18.1% for SAVR (p = 0.06); cardiovascular mortality was 7.0% for TAVR versus 13.8% for SAVR (p = 0.09). A combination of The Society of Thoracic Surgeons risk score greater than 7 and age greater than 80 years was a significant predictor of mortality, with TAVR demonstrating a survival advantage (p = 0.03). No differences were seen for stroke. The SAVR group had longer intensive care unit and hospital stays, increased incidence of acute kidney injury, life-threatening or disabling bleeding, and major adverse cardiac and cerebrovascular events (p < 0.05). Pacemaker implantation and paravalvular regurgitation were greater with TAVR at all timepoints. CONCLUSIONS For patients with prior coronary artery bypass graft surgery and aortic stenosis, TAVR offers a significant morbidity advantage and a strong trend toward improved survival over SAVR at 1 year.
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Affiliation(s)
- John V Conte
- Department of Surgery, The Johns Hopkins University, Baltimore, Maryland.
| | - Thomas G Gleason
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jon R Resar
- Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - David H Adams
- Department of Surgery, Mount Sinai Medical Center, New York, New York
| | - G Michael Deeb
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Jeffrey J Popma
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - G Chad Hughes
- Department of Surgery, Duke University, Durham, North Carolina
| | - George L Zorn
- Department of Surgery, University of Kansas, Lawrence, Kansas
| | - Michael J Reardon
- Department of Surgery, Houston-Methodist DeBakey Heart and Vascular Center, Houston, Texas
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