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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
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Transcatheter versus surgical aortic valve replacement in patients with prior coronary artery bypass graft operation:

Kevin L Greason1, Verghese Mathew1, Rakesh M Suri1

  • 1Mayo Clinic, Rochester, Minnesota.

The Annals of Thoracic Surgery
|June 3, 2014
PubMed

Insights

Surgical aortic valve replacement (SAVR) showed better outcomes than transcatheter aortic valve replacement (TAVR) in patients with prior coronary bypass grafting (CABG). Two-year follow-up revealed trends toward reduced mortality and hospitalization with SAVR.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Interventional Cardiology

Background:

  • The Placement of Aortic Transcatheter Valves (PARTNER) trial initially suggested reduced mortality with surgical aortic valve replacement (SAVR) over transcatheter aortic valve replacement (TAVR) in patients with prior coronary artery bypass grafting (CABG).
  • Further evaluation of this specific patient subgroup is warranted to understand long-term outcomes.

Purpose of the Study:

  • To compare the 2-year outcomes of SAVR versus TAVR in patients who have undergone prior CABG.
  • To analyze differences in mortality, stroke, myocardial infarction, and rehospitalization rates between SAVR and TAVR in this cohort.

Main Methods:

  • A retrospective analysis of 288 patients (41.2%) with a history of CABG from the PARTNER trial database.
  • Patients were followed for 2 years post-procedure, comparing outcomes between those who received SAVR (n=140) and TAVR (n=148).

Main Results:

  • Preoperative characteristics were similar between SAVR and TAVR groups.
  • No significant differences in operative death, stroke, or myocardial infarction were observed.
  • TAVR patients experienced more paravalvular regurgitation (p<0.0001).
  • At 2 years, a trend towards higher all-cause mortality was noted in the TAVR group (HR 1.53; p=0.052).
  • TAVR patients showed increased rates of repeated hospitalization (HR 1.75; p=0.05) and composite endpoints of death/rehospitalization (HR 1.52; p=0.02) or death/stroke (HR 1.51; p=0.05).

Conclusions:

  • Two-year follow-up in the PARTNER trial suggests superior outcomes for SAVR compared to TAVR in patients with a history of CABG.
  • Further long-term studies are needed to confirm these findings and elucidate underlying mechanisms.
Abstract

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