TY - JOUR
T1 - Impact of previous cardiac operations on patients undergoing transapical aortic valve implantation
T2 - Results from the italian registry of transapical aortic valve implantation
AU - D'Onofrio, Augusto
AU - Rubino, Paolo
AU - Fusari, Melissa
AU - Musumeci, Francesco
AU - Rinaldi, Mauro
AU - Alfieri, Ottavio
AU - Gerosa, Gino
PY - 2012/9
Y1 - 2012/9
N2 - Objectives: Redo cardiac surgery has an increased risk of morbidity and mortality when compared with the initial operation. The aim of this study was to assess the impact of previous cardiac operations on patients undergoing transapical aortic valve implantation (TA-TAVI). Methods: We analysed data from 566 patients included in the Italian Registry of Transapical Aortic Valve Implantation who underwent TA-TAVI implantation with the Sapien valve (Edwards Lifesciences, Irvine, CA, USA) from April 2008 through May 2011. Of these, 110 patients (19.4%) had already undergone at least one previous cardiac operation with opening of the pericardium (group R) while for 456 patients (80.6%) TA-TAVI was the first cardiac procedure (group F). Data were prospectively collected at each of the 20 participating centres and then sent to a central database for storage and analysis. Results: Preoperative logistic EuroSCORE was higher in group R (35 ± 18.6 vs. 23.5 ± 11.9%; P <0.001). Hospital mortality occurred in eight (7.2%) and 36 (7.9%) patients in groups R and F, respectively (P = 0.8). Mean follow-up was 10.4 ± 7.9 months (range: 1-34). Overall 2-year Kaplan-Meier survival was 64.2 ± 9.8 and 75.4 ± 3.5% in groups R and F, respectively (P = 0.69). Incidence of operative complications, postoperative bleeding, pacemaker implantation, myocardial infarction and stroke did not show statistically significant differences between groups. The univariate analysis showed that arterial hypertension, logistic EuroSCORE, porcelain aorta, left ventricular ejection fraction and previous percutaneous coronary interventions were significantly associated with 30-day mortality in group R. Conclusions: According to our data, patients undergoing TAVI with previous cardiac operations have a higher preoperative risk profile but have similar outcomes when compared with patients undergoing a first operation. In these subset of patients, TAVI is a promising therapeutic option.
AB - Objectives: Redo cardiac surgery has an increased risk of morbidity and mortality when compared with the initial operation. The aim of this study was to assess the impact of previous cardiac operations on patients undergoing transapical aortic valve implantation (TA-TAVI). Methods: We analysed data from 566 patients included in the Italian Registry of Transapical Aortic Valve Implantation who underwent TA-TAVI implantation with the Sapien valve (Edwards Lifesciences, Irvine, CA, USA) from April 2008 through May 2011. Of these, 110 patients (19.4%) had already undergone at least one previous cardiac operation with opening of the pericardium (group R) while for 456 patients (80.6%) TA-TAVI was the first cardiac procedure (group F). Data were prospectively collected at each of the 20 participating centres and then sent to a central database for storage and analysis. Results: Preoperative logistic EuroSCORE was higher in group R (35 ± 18.6 vs. 23.5 ± 11.9%; P <0.001). Hospital mortality occurred in eight (7.2%) and 36 (7.9%) patients in groups R and F, respectively (P = 0.8). Mean follow-up was 10.4 ± 7.9 months (range: 1-34). Overall 2-year Kaplan-Meier survival was 64.2 ± 9.8 and 75.4 ± 3.5% in groups R and F, respectively (P = 0.69). Incidence of operative complications, postoperative bleeding, pacemaker implantation, myocardial infarction and stroke did not show statistically significant differences between groups. The univariate analysis showed that arterial hypertension, logistic EuroSCORE, porcelain aorta, left ventricular ejection fraction and previous percutaneous coronary interventions were significantly associated with 30-day mortality in group R. Conclusions: According to our data, patients undergoing TAVI with previous cardiac operations have a higher preoperative risk profile but have similar outcomes when compared with patients undergoing a first operation. In these subset of patients, TAVI is a promising therapeutic option.
KW - Heart
KW - Heart valve
KW - Outcomes
KW - Percutaneous
KW - Reoperation
KW - Transapical
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U2 - 10.1093/ejcts/ezs027
DO - 10.1093/ejcts/ezs027
M3 - Article
C2 - 22351707
AN - SCOPUS:84871891643
VL - 42
SP - 480
EP - 485
JO - European Journal of Cardio-thoracic Surgery
JF - European Journal of Cardio-thoracic Surgery
SN - 1010-7940
IS - 3
M1 - ezs027
ER -