1. Results of surgical aortic valve replacement and transapical transcatheter aortic valve replacement in patients with previous coronary artery bypass grafting
- Author
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Davide Gabbieri, Marco Agrifoglio, Alessandro Minati, Ugolino Livi, Fausto Biancari, Francesco Musumeci, Giampiero Esposito, Marisa De Feo, Andrea Agostinelli, Carlo Savini, Francesco Onorati, Mauro Rinaldi, Giovanni Mariscalco, Mauro Cassese, Francesco Santini, Giuseppe Santarpino, Vincenzo Lucchetti, Ottavio Alfieri, Augusto D'Onofrio, Domenico Mangino, Omar Di Gregorio, Stefano Salizzoni, Giuseppe Punta, Giuseppe Faggian, Giovanni Troise, Marco Aiello, Ester Dalla Ratta, Paolo Magagna, Antonio Messina, Theodor Fischlein, Gino Gerosa, Tatu Juvonen, Giancarlo Passerone, Mattia Glauber, Cesare Beghi, Onorati, Francesco, D'Onofrio, Augusto, Biancari, Fausto, Salizzoni, Stefano, DE FEO, Marisa, Agrifoglio, Marco, Mariscalco, Giovanni, Lucchetti, Vincenzo, Messina, Antonio, Musumeci, Francesco, Santarpino, Giuseppe, Esposito, Giampiero, Santini, Francesco, Magagna, Paolo, Beghi, Cesare, Aiello, Marco, Ratta, Ester Dalla, Savini, Carlo, Troise, Giovanni, Cassese, Mauro, Fischlein, Theodor, Glauber, Mattia, Passerone, Giancarlo, Punta, Giuseppe, Juvonen, Tatu, Alfieri, Ottavio, Gabbieri, Davide, Mangino, Domenico, Agostinelli, Andrea, Livi, Ugolino, Di Gregorio, Omar, Minati, Alessandro, Rinaldi, Mauro, Gerosa, Gino, Faggian, Giuseppe, 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, Ed, Savini, C, Troise, G, Cassese, M, Fischlein, T, Glauber, M, Passerone, G, Punta, G, Juvonen, T, Gabbieri, D, Mangino, D, Agostinelli, A, Livi, U, Di Gregorio, O, Minati, A, Rinaldi, M, Gerosa, G, and Faggian, G.
- Subjects
Aortic valve disease ,Aortic valve replacement ,Bioprosthesis malfunction ,Redo ,Transapical transcatheter aortic valve replacement ,Aged ,Aortic Valve ,Aortic Valve Stenosis ,Coronary Artery Disease ,Female ,Humans ,Incidence ,Italy ,Male ,Postoperative Complications ,Risk Factors ,Sternotomy ,Transcatheter Aortic Valve Replacement ,Treatment Outcome ,Coronary Artery Bypass ,Heart Valve Prosthesis ,Surgery ,Pulmonary and Respiratory Medicine ,Cardiology and Cardiovascular Medicine ,Aortic valve ,Bypass grafting ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Coronary artery disease ,0302 clinical medicine ,Valve replacement ,medicine.anatomical_structure ,Aortic valve stenosis ,Cardiology ,Artery ,medicine.medical_specialty ,03 medical and health sciences ,Incidence Italy ,Internal medicine ,medicine ,Aortic valve disease, Aortic valve replacement, Bioprosthesis malfunction, Redo, Transapical transcatheter aortic valve replacement, Aged, Aortic Valve, Aortic Valve Stenosis, Coronary Artery Disease, Female, Humans, Incidence Italy, Male, Postoperative Complications, Risk Factors, Sternotomy, Transcatheter Aortic Valve Replacement, Treatment Outcome, Coronary Artery Bypass, Heart Valve Prosthesis ,In patient ,business.industry ,medicine.disease ,030228 respiratory system ,ORIGINAL ARTICLES ,business - 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.
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- 2016