Results of surgical aortic valve replacement and transapical transcatheter aortic valve replacement in patients with previous coronary artery bypass grafting

Francesco Onorati, Augusto D'Onofrio, Fausto Biancari, Stefano Salizzoni, Marisa De Feo, Marco Agrifoglio, Giovanni Mariscalco, Vincenzo Lucchetti, Antonio Messina, Francesco Musumeci, Giuseppe Santarpino, Giampiero Esposito, Francesco Santini, Paolo Magagna, Cesare Beghi, Marco Aiello, Ester Dalla Ratta, Carlo Savini, Giovanni Troise, Mauro CasseseTheodor Fischlein, Mattia Glauber, Giancarlo Passerone, Giuseppe Punta, Tatu Juvonen, Ottavio Alfieri, Davide Gabbieri, Domenico Mangino, Andrea Agostinelli, Ugolino Livi, Omar Di Gregorio, Alessandro Minati, Mauro Rinaldi, Gino Gerosa, Giuseppe Faggian

Research output: Contribution to journalArticle

Abstract

OBJECTIVES 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). METHODS 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. RESULTS 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. CONCLUSIONS 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.

Original languageEnglish
Pages (from-to)806-812
Number of pages7
JournalInteractive Cardiovascular and Thoracic Surgery
Volume22
Issue number6
DOIs
Publication statusPublished - Jun 25 2016

Keywords

  • Aortic valve disease
  • Aortic valve replacement
  • Bioprosthesis malfunction
  • Redo
  • Transapical transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

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    Onorati, F., D'Onofrio, A., Biancari, F., Salizzoni, S., De Feo, M., Agrifoglio, M., Mariscalco, G., Lucchetti, V., Messina, A., Musumeci, F., Santarpino, G., Esposito, G., Santini, F., Magagna, P., Beghi, C., Aiello, M., Ratta, E. D., Savini, C., Troise, G., ... Faggian, G. (2016). Results of surgical aortic valve replacement and transapical transcatheter aortic valve replacement in patients with previous coronary artery bypass grafting. Interactive Cardiovascular and Thoracic Surgery, 22(6), 806-812. https://doi.org/10.1093/icvts/ivw049