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Results of surgical aortic valve replacement and transapical transcatheter aortic valve replacement in patients with previous coronary artery bypass grafting. 2016
Francesco Onorati, and
Augusto D'Onofrio, and
Fausto Biancari, and
Stefano Salizzoni, and
Marisa De Feo, and
Marco Agrifoglio, and
Giovanni Mariscalco, and
Vincenzo Lucchetti, and
Antonio Messina, and
Francesco Musumeci, and
Giuseppe Santarpino, and
Giampiero Esposito, and
Francesco Santini, and
Paolo Magagna, and
Cesare Beghi, and
Marco Aiello, and
Ester Dalla Ratta, and
Carlo Savini, and
Giovanni Troise, and
Mauro Cassese, and
Theodor Fischlein, and
Mattia Glauber, and
Giancarlo Passerone, and
Giuseppe Punta, and
Tatu Juvonen, and
Ottavio Alfieri, and
Davide Gabbieri, and
Domenico Mangino, and
Andrea Agostinelli, and
Ugolino Livi, and
Omar Di Gregorio, and
Alessandro Minati, and
Mauro Rinaldi, and
Gino Gerosa, and
Giuseppe Faggian, and
Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy francesco.onorati@ospedaleuniverona.it.
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). 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. 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. 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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