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Transcatheter or Surgical Aortic Valve Replacement in Patients With Prior Coronary Artery Bypass Grafting

John V Conte1, Thomas G Gleason2, Jon R Resar3

  • 1Department of Surgery, The Johns Hopkins University, Baltimore, Maryland.

The Annals of Thoracic Surgery
|October 5, 2015
PubMed

Insights

Transcatheter aortic valve replacement (TAVR) shows improved survival trends and reduced morbidity compared to surgical aortic valve replacement (SAVR) in patients with prior coronary artery bypass graft surgery and aortic stenosis.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Aortic stenosis (AS) management in patients with prior coronary artery bypass graft (CABG) surgery presents unique challenges.
  • Both transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) are viable treatment options for this population.
  • The CoreValve High Risk (CHR) study provides valuable data on clinical outcomes for these patients.

Purpose of the Study:

  • To compare the major clinical outcomes of TAVR versus SAVR in patients with AS and prior CABG surgery.
  • To assess 1-year all-cause mortality and other critical secondary endpoints.
  • To identify predictors of mortality in this high-risk cohort.

Main Methods:

  • Analysis of 226 patients from the CHR study with prior CABG surgery, undergoing either TAVR (n=115) or SAVR (n=111).
  • Primary endpoint: 1-year all-cause mortality.
  • Secondary endpoints included cardiovascular mortality, stroke, length of stay, acute kidney injury, bleeding events, and major adverse cardiac and cerebrovascular events (MACCE).

Main Results:

  • At 1-year follow-up, TAVR showed a trend towards lower all-cause mortality (9.6% vs. 18.1%, p=0.06) and cardiovascular mortality (7.0% vs. 13.8%, p=0.09) compared to SAVR.
  • High Society of Thoracic Surgeons (STS) risk score (>7) and age (>80) predicted mortality, with TAVR demonstrating a survival advantage (p=0.03).
  • SAVR was associated with longer ICU/hospital stays, increased acute kidney injury, life-threatening bleeding, and MACCE (p < 0.05), while TAVR had higher rates of pacemaker implantation and paravalvular regurgitation.

Conclusions:

  • For patients with AS and prior CABG, TAVR offers a significant advantage in reducing morbidity compared to SAVR.
  • TAVR demonstrates a strong trend towards improved survival at 1 year in this specific patient group.
  • These findings support TAVR as a favorable alternative for select high-risk patients with aortic stenosis and prior bypass surgery.
Abstract

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