Abstract 20354: Comparison of Conventional Re-do Surgery and Transcatheter Aortic Valve Implantation after CABG Surgery
Objective: Surgical aortic valve replacement (SAVR) with the use of cardiopulmonary bypass is the standard treatment for symptomatic aortic valve stenosis. The perioperative risk is increased in patients with previous cardiac surgery. Transcatheter Aortic Valve Implantation (TAVI) represents an alternativetreatment option in these patients. This study evaluates perioperative and mid-term clinical outcome of patients undergoing either Re-do surgery or TAVI.
Methods: We compared patients undergoing surgical or transcatheter aortic valve treatment after prior coronary artery bypass graft surgery (CABG) between 01/2005 and 04/2010. The patient population consists of 81 consecutive patients with previous CABG undergoing reoperation (n=40, 85% male gender) or TAVI (n=41, 78% male gender). Standard redo surgery was performed using median sternotomy and extracorporeal circulation. TAVI patients underwent either transfemoral (73%), transapical (21%) or transsubclavian (6%) implantation of Medtronic CoreValve or Edwards Sapien bioprostheses. Follow-up was achieved in all patients clinically and with echocardiography at 3 months up to 5 years.
Results: TAVI patients were significantly older (79 ± 5 vs. 71 ± 8years, p<0.001) and presented with higher logistic (34.5 ± 17 vs. 23.5 ± 20, p=0.01) and additive EuroScore values (12.2 ± 2 vs. 10.5 ± 3; p=0.009). Baseline ejection fraction (48.7 ± 14 vs. 46.9 ± 15, p=ns) and aortic valve area (0.63 ± 0.2 vs. 0.66 ± 0.2, p=ns) were similar among both groups. At 30 days, mortality was 2.4% among patients undergoing TAVI and 2.5% among patients undergoing redo-surgery (P=ns).
Conclusions: TAVI represents a valuable and safe alternative to re-do aortic valve replacement after previous CABG in high risk patients.
- © 2010 by American Heart Association, Inc.