Aortic valve replacement in patients with previous coronary artery bypass grafting: 10-year experience

Abstract

AVR post-CABG with patent grafts can be performed in high-risk patients with excellent short- and long-term outcomes and appears to be superior to published catheter-based interventions. In the absence of randomized trial data, we believe that open AVR remains the treatment of choice for aortic valve disease following prior CABG.

Transcatheter or Surgical Aortic Valve Replacement in Patients With Prior Coronary Artery Bypass Grafting

“…Before the development of TAVR, patients with prior cardiac surgery who had aortic stenosis routinely underwent SAVR. Outcomes were generally good, with an operative mortality rate of less than 5% and excellent 1-year survival [6][7][8][9][10][11][12][13]. The development of TAVR has mandated a reevaluation of SAVR results of patients with aortic stenosis after CABG.…”

“…Although SAVR after CABG can result in excellent outcomes, the operations can be technically challenging. Furthermore, SAVR after previous cardiac surgery, including CABG, has an increased risk of morbidity and mortality compared with that observed after primary SAVR [3][4][5][6][7][8][9][10][11][12][13].…”

Appropriate patient selection or health care rationing? Lessons from surgical aortic valve replacement in the Placement of Aortic Transcatheter Valves I trial

“…4 However, as surgical AVR has matured, it can be performed safely in the setting of previous CABG. [31][32][33] Findings Placed in the Context of Today's Health Care Climate (Appendix E3 E1-E15 ) Indication for surgical AVR in patients with severe aortic stenosis is based classically on a positive benefit-to-risk ratio of prolonged life expectancy of greater quality than that of natural history. 34 In real life, however, decisions for or against surgery are also influenced by referring physicians and cardiologists, and, increasingly, institutional quality rankings and alignment of physicians with institutions.…”

Propensity matched comparison of in‐hospital outcomes of TAVR vs. SAVR in patients with previous history of CABG: Insights from the Nationwide inpatient sample

“…The annual number of patients with previous history of CABG receiving AVR tripled during the years from 2007 to 2013 . SAVR has been the standard of care for AVR in patients with prior CABG; however, repeat sternotomy is challenging because of the difficulties in myocardial protection, increased risk of bleeding, and graft injury due to fibrous adhesions . Patients with severe symptomatic AS and previous history of heart surgeries form the high‐risk group that could benefit from the minimally invasive approach of TAVR .…”