Original article
Adult cardiac
Transcatheter Aortic Valve Implantation or Surgical Aortic Valve Replacement as Redo Procedure After Prior Coronary Artery Bypass Grafting

Presented at the Forty-seventh Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 31–Feb 2, 2011.
https://doi.org/10.1016/j.athoracsur.2011.05.106Get rights and content

Background

The perioperative risk for redo surgical aortic valve replacement (S-AVR) in patients with severe aortic stenosis and prior coronary artery bypass grafting (CABG) is increased. Transcatheter aortic valve implantation (TAVI) represents an alternative. We assessed the perioperative and mid-term clinical outcome of patients undergoing S-AVR or TAVI.

Methods

In a retrospective observational, comparative study, 40 consecutive patients underwent redo operation with S-AVR or TAVI between April 2005 and April 2010. Median sternotomy and extracorporeal circulation were used for S-AVR; TAVI access was transfemoral (n = 27; 67.5%), transapical (n = 11; 27.5%), or transsubclavian (n = 2; 5.0%). Clinical and echocardiographic follow-up was at 30 days and 6 months.

Results

TAVI patients were older (78.5 ± 6 vs 70.6 ± 8 years, p < 0.001) and presented higher logistic (33.5 ± 17 vs 20.2 ± 14, p < 0.001) European System for Cardiac Operative Risk Evaluation scores. All-cause mortality was 2.5% in both groups and major adverse cardiac and cerebrovascular event rates were comparable (7.5% TAVI vs 17.5% S-AVR, p = 0.311) after 30 days. TAVI was associated with a higher rate of permanent pacemaker implantation (30% vs 0%, p < 0.001) and grade II residual aortic regurgitation in 14%. Incidence of cerebrovascular events was 7.5% in S-AVR vs 2.5% in TAVI (p = 0.61).

Conclusions

In elderly, high-risk patients after prior CABG, conventional aortic valve replacement and TAVI are comparable treatment options with favorable clinical outcome. A redo operation itself does not sufficiently justify a TAVI approach.

Section snippets

Patients and Methods

The Institutional Review Board approved the study and individual patient consent was waived.

Results

Between April 2005 and April 2010, 40 patients received S-AVR as a redo procedure after previous CABG. Thirty-five patients (87.5%) were treated with biologic, 2 patients (5%) with mechanical valve prostheses, and 3 patients (7.5%) received an apical-descendens conduit.

Baseline patient characteristics are reported in Table 1. Sex distribution and comorbidities were similar in both groups, except that the TAVI patients were significantly older and presented more frequently with peripheral

Comment

The present study shows that aortic valve replacement in patients with previous CABG can be performed with favorable and similar medium-term clinical results and low mortality by S-AVR as well as by TAVI.

Patients with previous cardiac interventions—most frequently CABG—are considered to be at increased perioperative risk when undergoing redo cardiac operations and constitute 5% to 16% of all patients undergoing S-AVR [12, 13, 14]. With this study we assessed the outcome of TAVI and compared

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Drs Stortecky and Brinks contributed equally.

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