Stentless Bioprostheses for Aortic Valve Replacement in Octogenarians: The Influence of Coronary Artery Disease

Ennker, J.; Zadeh, B Soroor Azim; Pons-Kuehnemann, Joern; Niemann, Bernd; Grieshaber, Philippe; Ennker, I. C.; Boening, Andreas

doi:10.1055/s-0037-1604048

Cited by 2 publications

(3 citation statements)

References 21 publications

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“…Across the included studies, the reported mean follow-up ranged between 2.4 [ 16 ] and 6.6 years [ 18 ] with a weighted mean follow-up of 5.1 years. The longest follow-up was 15 years [ 22 ]. All included studies reported at least 5-year follow-up.…”

Section: Resultsmentioning

confidence: 99%

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The impact of coronary artery bypass grafting added to aortic valve replacement on long-term outcomes in octogenarian patients: a reconstructed time-to-event meta-analysis

Gallingani

D’Alessandro

Singh

et al. 2022

Interactive CardioVascular and Thoracic Surgery

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OBJECTIVES The long-term results in studies comparing octogenarian patients who received either isolated surgical aortic valve replacement (i-SAVR) or coronary artery bypass grafting (CABG) in addition to SAVR are still debated. We performed a reconstructed time-to-event data meta-analysis of studies comparing i-SAVR and CABG+SAVR to evaluate the impact of CABG and to analyse the time-varying effects on long-term outcome. METHODS We performed a systematic review of the literature from January 2000 through November 2021, including studies comparing i-SAVR and CABG+SAVR which reported at least 3-years follow-up and that plotted Kaplan–Meier curves of overall survival. The primary endpoint was overall long-term survival; secondary endpoints were in-hospital/30-day mortality and postoperative outcomes. The pooled hazard ratio (HR) and odd ratio (OR) with 95% confidence interval (CI) were calculated for primary and secondary endpoints, respectively. Random-effect model was used in all analyses. RESULTS Sixteen retrospective studies were included (5382 patients, i-SAVR=2,568 and CABG+SAVR=2,814). I-SAVR showed a lower incidence of in-hospital mortality compared to CABG+SAVR (OR = 0.73; 95% CI = 0.60–0.89; p = 0.002). Landmark analyses showed a significantly higher all-cause mortality within 1-year from surgery in CABG+SAVR (HR = 1.17; 95% CI = 1.01–1.36; p = 0.03); after 1-year, no significant difference was observed (HR = 0.95; 95% CI = 0.87–1.04; p = 0.35). Landmark analysis was confirmed by time-varying-trend of hazard ratio CONCLUSIONS Late survival of octogenarians did not differ significantly between the two interventions. Interestingly, CABG added to SAVR was associated with both higher in-hospital and within 1-year mortality after surgery, whereas this difference was statistically non-significant at long-term follow-up.

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Section: Resultsmentioning

confidence: 99%

“…Nine studies presented data on postoperative CVE [ 3 , 4 , 15–17 , 19 , 20 , 22 , 23 ]. There was no difference between the 2 groups (OR = 0.92; 95% CI = 0.61–1.39; P = 0.69) and no heterogeneity was revealed across the studies ( I 2 = 0%; Supplementary Material, Fig.…”

Section: Resultsmentioning

confidence: 99%

The impact of coronary artery bypass grafting added to aortic valve replacement on long-term outcomes in octogenarian patients: a reconstructed time-to-event meta-analysis

Gallingani

D’Alessandro

Singh

et al. 2022

Interactive CardioVascular and Thoracic Surgery

View full text Add to dashboard Cite

show abstract

“…3B). When we restricted the analysis for those studies ( n = 12) [ 7 , 9 , 10 , 13 , 19 , 20 , 38 , 39 , 41 , 45 , 51 , 52 ] reporting a maximum follow-up of 10 years or more, the pooled analysis revealed no differences between the two groups (HR = 0.97; 95% CI 0.87–1.09; p = 0.64) with evidence of moderate heterogeneity ( I 2 = 44%; Tau 2 = 0.01; p = 0.05) (Fig. 2 B) and with no evidence of publication bias (Egger’s linear regression test: p = 0.83; Begg and Mazumdar’s test: p = 0.90) (Supplemental material, Fig.…”

Section: Resultsmentioning

confidence: 99%

The early and long-term outcomes of coronary artery bypass grafting added to aortic valve replacement compared to isolated aortic valve replacement in elderly patients: a systematic review and meta-analysis

et al. 2022

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In aged population, the early and long-term outcomes of coronary revascularization (CABG) added to surgical aortic valve replacement (SAVR) compared to isolated SAVR (i-SAVR) are conflicting. To address this limitation, a meta-analysis comparing the early and late outcomes of SAVR plus CABG with i-SAVR was performed. Electronic databases from January 2000 to November 2021 were screened. Studies reporting early-term and long-term comparison between the two treatments in patients over 75 years were analyzed. The primary endpoints were in-hospital/30-day mortality and overall long-term survival. The pooled odd ratio (OR) and hazard ratio (HR) with 95% confidence interval (CI) were calculated for in-early outcome and long-term survival, respectively. Random-effect model was used in all analyses. Forty-four retrospective observational studies reporting on 74,560 patients (i-SAVR = 36,062; SAVR + CABG = 38,498) were included for comparison. The pooled analysis revealed that i-SAVR was significantly associated with lower rate of early mortality compared to SAVR plus CABG (OR = 0.70, 95% CI 0.66–0.75; p < 0.0001) and with lower incidence of postoperative acute renal failure (OR = 0.65; 95% CI 0.50–0.91; p = 0.02), need for dialysis (OR = 0.65; 95% CI 0.50–0.86; p = 0.002) and prolonged mechanical ventilation (OR = 0.57; 95% CI 0.42–0.77; p < 0.0001). Twenty-two studies reported data of long-term follow-up. No differences were reported between the two groups in long-term survival (HR = 0.95; 95% CI 0.87–1.03; p = 0.23). CABG added to SAVR is associated with worse early outcomes in terms of early mortality, postoperative acute renal failure, and prolonged mechanical ventilation. Long-term survival was comparable between the two treatments.

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Stentless Bioprostheses for Aortic Valve Replacement in Octogenarians: The Influence of Coronary Artery Disease

Abstract: Use of the Freestyle stentless valve prosthesis for AVR is feasible also in octogenarians. The existence of coronary artery disease leads to concomitant bypass surgery, but not a higher level of perioperative or long-term mortality.

Cited by 2 publications

References 21 publications

The impact of coronary artery bypass grafting added to aortic valve replacement on long-term outcomes in octogenarian patients: a reconstructed time-to-event meta-analysis

The impact of coronary artery bypass grafting added to aortic valve replacement on long-term outcomes in octogenarian patients: a reconstructed time-to-event meta-analysis

The early and long-term outcomes of coronary artery bypass grafting added to aortic valve replacement compared to isolated aortic valve replacement in elderly patients: a systematic review and meta-analysis

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