1. Left Ventricular Function Recovery After Transapical TAVR in Patients With Previous Coronary Artery Bypass Graft Surgery
- Author
-
Nathan Kang, Bruce Haik, Marc Cohen, Chunguang Chen, Alexis K. Okoh, Christoph Sossou, Mark J. Russo, Devangi Dave, and Jonathan Decker
- Subjects
Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Transcatheter aortic ,medicine.medical_treatment ,Coronary Disease ,Kaplan-Meier Estimate ,Ventricular Function, Left ,Transcatheter Aortic Valve Replacement ,Valve replacement ,medicine ,Humans ,In patient ,cardiovascular diseases ,Coronary Artery Bypass ,Retrospective Studies ,Aged, 80 and over ,Ejection fraction ,Ventricular function ,business.industry ,Aortic Valve Stenosis ,General Medicine ,medicine.disease ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Aortic valve stenosis ,Female ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
Objective The transapical (TA) approach is an alternative access technique for transcatheter aortic valve replacement (TAVR) in patients with symptomatic aortic valve stenosis. The impact of prior coronary artery bypass graft (CABG) surgery and how it affects left ventricular function recovery is not well defined. Methods Patients who had TAVR at a single center between June 2012 and December 2016 were reviewed. High-risk patients who underwent the procedure via a TA approach were divided into 2 groups based on their history of CABG surgery. Postoperative outcomes were compared between groups. CABG/TA-TAVR patients were subdivided into 2 per baseline left ventricular ejection fraction (LVEF) Results Of 923 cases in total, 183 (19.8%) were performed via a TA approach. The mean ± SD Society of Thoracic Surgeons risk score of TA patients was 10.2 ± 4.6. Forty-nine (27%) had a surgical history of CABG. Overall all-cause mortality rates at 30 days, 1 year, and 2 years were similar for both groups ( P = 0.59, P = 0.64, P = 0.78). Subgrouping of CABG-TAVR patients ( n = 49) identified 24 patients (49%) with LVEF ≥50% vs. 25 (51%) with LVEF 2, P < 0.001; mean gradient: ∆: −38 mmHg, P < 0.001); LVEF 2, P < 0.001; MG: ∆: −31 mmHg, P < 0.001). Conclusions TA-TAVR can be safely performed with acceptable postoperative outcomes in patients with a history of CABG surgery. In those with reduced EF, significant improvements in LV and valve functions are seen at 1-year follow-up.
- Published
- 2019
- Full Text
- View/download PDF