Abstract 18287: Transapical Aortic Valve Implantation Compares Favourably to Conventional Aortic Valve Replacement in High-Risk Patients with Severe Aortic Stenosis and Previous Coronary Artery Bypass Grafting
Background: Conventional surgical aortic valve replacement (SAVR) in patients with previous coronary artery bypass grafting has been associated with a higher risk. Transcatheter transapical aortic valve implantation (TAVI) has become an alternative to SAVR in patients considered to be at very high surgical risk. However, it is not known whether TAVI might be associated with a lower mortality and morbidity than SAVR in redo patients.
Hypothesis: The aim of this study was to compare results of TAVI versus SAVR in patients with previous coronary bypass grafting.
Methods: A total of 35 consecutive patients with previous coronary artery bypass surgery who underwent TAVI with the Edwards-Sapien valve from May 2007 to February 2010 were matched 1:1 for the Society of Thoracic Surgeons (STS) score with patients with previous coronary artery bypass surgery who had SAVR between January 2000 and February 2010 in our institution. The 30-day clinical results and valve hemodynamics were compared between groups.
Results: The mean STS score was similar in the two groups (TAVI: 8.4±0.5%, SAVR: 8.5±0.04%, p=0.94) but TAVI patients were older (78±1 vs. 74±1 years p=0.085), were more frequently female (58% vs 23%, p=0.020) and tended to have more frequently moderate-to-severe mitral regurgitation (25.7% Vs 7.7 %, p= 0.12). The procedure was successful in all patients in both groups. TAVI was associated with a lower rate of bleeding requiring blood transfusions (44.1% vs. 84.1%, p=0.003) and post-procedural significant cardiac enzyme elevation (2.9% vs. 27.8%, p=0.006). The 30-day mortality (5.7% vs. 15.5%, p=0.42) and 1 year mortality (8.6% vs. 20.8%, p=0.34) tended to be lower in the TAVI group compared to the SAVR group. Post-operative mean transaortic gradient was similar between the 2 groups (TAVI: 10.6±4.1 mmHG; SARV:12.7±1 mmHg p=0.18) and mean aortic valve area was bigger in TAVI group (1.6±0.05 cm2 vs 1.4±0.05 cm2 p=0.02).
Conclusions: TAVI in high-risk patients with aortic stenosis and previous CABG is associated with lower peri-operative morbidity and tendency towards lower mortality compared with SAVR. These results support further research to evaluate whether TAVI should become the treatment of choice for redo patients.
- © 2010 by American Heart Association, Inc.