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

Conte, John V.; Gleason, Thomas G.; Resar, Jon R.; Adams, David H.; Deeb, G. Michael; Popma, Jeffrey J.; Hughes, G. Chad; Zorn, George L.; Reardon, Michael J.

doi:10.1016/j.athoracsur.2015.06.067

Cited by 23 publications

(33 citation statements)

References 32 publications

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“…A total of seven studies (3 randomized trials, 4 cohort) including 9221 patients (4055 in the TAVR group and 4166 in the SAVR group) were included in the analysis [ 5 , 6 , 7 , 8 , 9 , 10 , 11 ]. Out of these, three were randomized control trials and four were prospective cohort studies.…”

Section: Resultsmentioning

confidence: 99%

Transcatheter Versus Surgical Aortic Valve Replacement in Patients with Cardiac Surgery: Meta-Analysis and Systematic Review of the Literature

Latif

Lateef

Ahsan

et al. 2020

JCDD

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The number of patients with severe aortic stenosis (AS) and a history of prior cardiac surgery has increased. Prior cardiac surgery increases the risk of adverse outcomes in patients undergoing aortic valve replacement. To evaluate the impact of prior cardiac surgery on clinical endpoints in patients undergoing transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR), we performed a literature search using PubMed, Embase, Google Scholar, and Scopus databases. The clinical endpoints included in our study were 30-day mortality, 1–2-year mortality, acute kidney injury (AKI), bleeding, stroke, procedural time, and duration of hospital stay. Seven studies, which included a total of 8221 patients, were selected. Our study found that TAVR was associated with a lower incidence of stroke and bleeding complications. There was no significant difference in terms of AKI, 30-day all-cause mortality, and 1–2-year all-cause mortality between the two groups. The average procedure time and duration of hospital stay were 170 min less (p ≤ 0.01) and 3.6 days shorter (p < 0.01) in patients with TAVR, respectively. In patients with prior coronary artery bypass graft and severe AS, both TAVR and SAVR are reasonable options. However, TAVR may be associated with a lower incidence of complications like stroke and perioperative bleeding, in addition to a shorter length of stay.

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Section: Resultsmentioning

confidence: 99%

Transcatheter Versus Surgical Aortic Valve Replacement in Patients with Cardiac Surgery: Meta-Analysis and Systematic Review of the Literature

Latif

Lateef

Ahsan

et al. 2020

JCDD

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“…The PARTNER‐2 trial showed no significant difference in mortality at 1 year between TAVR and SAVR . Whereas the CHR study showed better mortality rates with TAVR compared to SAVR . The newer generation SAPIEN XT heart valve system ( Edwards Lifesciences, Irvine, CA ) was used in the PARTNER‐ 2 trial while first generation balloon expandable SAPIEN heart valve system ( Edwards Lifesciences, Irvine, CA ) was used in the PARTNER trial; newer generation TAVR devices have been shown to have improved outcomes over the first generation devices .…”

Section: Discussionmentioning

confidence: 99%

“…The newer generation SAPIEN XT heart valve system ( Edwards Lifesciences, Irvine, CA ) was used in the PARTNER‐ 2 trial while first generation balloon expandable SAPIEN heart valve system ( Edwards Lifesciences, Irvine, CA ) was used in the PARTNER trial; newer generation TAVR devices have been shown to have improved outcomes over the first generation devices . The disparity in the results between PARTNER and CHR study can potentially be attributed to variations in baseline risk scores and differences in the number of patients developing paravalvular leak (PVL), which were lower in CHR study compared to the PARTNER trial . The severity of PVL has been directly linked to increased risk of postoperative mortality .…”

Section: Discussionmentioning

confidence: 99%

“…The disparity in the results between PARTNER and CHR study can potentially be attributed to variations in baseline risk scores and differences in the number of patients developing paravalvular leak (PVL), which were lower in CHR study compared to the PARTNER trial . The severity of PVL has been directly linked to increased risk of postoperative mortality . Furthermore, accumulating operator experience in tandem with constantly evolving TAVR technology may have also led to improved outcomes .…”

Section: Discussionmentioning

confidence: 99%

“…About 25.5–42% of the patients undergoing TAVR have had prior CABG . There is limited available data comparing TAVR and SAVR in patients with previous history of CABG . Utilizing a large nationwide inpatient health care database, we evaluate real world data to compare in‐hospital outcomes of SAVR and TAVR in patients with prior history of CABG.…”

Section: Introductionmentioning

confidence: 99%

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

Nalluri

Atti

Patel

et al. 2018

Cathet Cardio Intervent

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Comparison of Outcomes After Transcatheter vs Surgical Aortic Valve Replacement Among Patients at Intermediate Operative Risk With a History of Coronary Artery Bypass Graft Surgery

et al. 2019

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IMPORTANCE Surgical aortic valve replacement (SAVR) has increased risk for patients with aortic stenosis (AS) and a history of coronary artery bypass graft (CABG) surgery. Transcatheter aortic valve replacement (TAVR) may be an alternative. OBJECTIVE To compare TAVR with SAVR outcomes in patients at intermediate operative risk with prior CABG surgery. DESIGN, SETTING, AND PARTICIPANTS In this post hoc analysis of the Surgical Replacement and Transcatheter Aortic Valve Implantation (SURTAVI) noninferiority randomized clinical trial, patients with severe, symptomatic AS at intermediate operative risk were enrolled from 87 centers across the United States, Europe, and Canada from June 2012 to June 2016 and followed-up with up to July 2017. Those with a history of CABG surgery were considered for analysis. Data were analyzed from September to December 2017. INTERVENTIONS A total of 1746 patients were enrolled and randomized 1:1 to self-expanding TAVR or SAVR. An implant was attempted in 1660 patients, of whom 273 had prior CABG surgery, including 136 who underwent attempted TAVR and 137 who underwent attempted SAVR. MAIN OUTCOMES AND MEASURES The primary outcome was all-cause mortality or disabling stroke at 1-year follow-up. Efficacy outcomes included quality of life, measured using the Kansas City Cardiomyopathy Questionnaire at 30 days, 6 months, and 1 year, and distance walked in 6 minutes, measured using the 6-minute walk test at 30 days and 1 year. RESULTS Of the 136 patients in the TAVR cohort, 111 (81.6%) were male, and the mean (SD) age was 76.9 (6.5) years; of the 137 in the SAVR cohort, 117 (85.4%) were male, and the mean (SD) age was 76.6 (6.5) years. The mean (SD) Society of Thoracic Surgeons Predicted Risk of Mortality score was 5.0% (1.6%) in the TAVR cohort and 5.2% (1.7%) in the SAVR cohort. All-cause mortality or disabling stroke at 1-year follow-up was 8.9% (95% CI, 5.2-15.2) in the TAVR cohort and 6.7% (95% CI, 3.5-12.8) in the SAVR cohort (log-rank P = .53). Compared with patients receiving SAVR, the mean (SD) Kansas City Cardiomyopathy Questionnaire summary score was significantly better among patients receiving TAVR at 30 days (81.4 [19.2] vs 69.7 [22.6]; P < .001); treatments were similar at 1 year (85.7 [14.6] vs 82.8 [18.4]; P = .19). Compared with patients in the SAVR cohort, those in the TAVR cohort showed greater mean (SD) improvement in distance walked at 1 year (48.3 [120.6] m vs 16.8 [88.7] m; P = .04). CONCLUSIONS AND RELEVANCE Both TAVR and SAVR were safe for intermediate-risk patients with AS and prior CABG surgery. The transcatheter approach facilitated faster improvement in quality of life and better exercise capacity at 1-year follow-up. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01586910

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

Abstract: 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.

Cited by 23 publications

References 32 publications

Transcatheter Versus Surgical Aortic Valve Replacement in Patients with Cardiac Surgery: Meta-Analysis and Systematic Review of the Literature

Transcatheter Versus Surgical Aortic Valve Replacement in Patients with Cardiac Surgery: Meta-Analysis and Systematic Review of the Literature

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

Comparison of Outcomes After Transcatheter vs Surgical Aortic Valve Replacement Among Patients at Intermediate Operative Risk With a History of Coronary Artery Bypass Graft Surgery

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