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Previous coronary artery bypass graft is not associated with higher mortality in transcatheter aortic valve

Narut Prasitlumkum1, Jakrin Kewcharoen1, Chanavuth Kanitsoraphan1

  • 1Internal Medicine Residency Program, University of Hawaii, Honolulu, HI, USA.

Acta Cardiologica
|January 17, 2019
PubMed

Insights

Patients who had previous coronary artery bypass graft (CABG) surgery do not face increased mortality risk when undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis. This meta-analysis confirms TAVR is a safe option regardless of prior CABG status.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Clinical Epidemiology

Background:

  • Patients with prior coronary artery bypass graft (CABG) are often considered high-risk for cardiac procedures.
  • Severe aortic stenosis (AS) necessitates intervention, with transcatheter aortic valve replacement (TAVR) being a key treatment.
  • The impact of previous CABG on TAVR outcomes, specifically mortality, requires robust evaluation.

Purpose of the Study:

  • To conduct a systematic review and meta-analysis.
  • To assess the association between previous CABG and mortality in patients undergoing TAVR for severe AS.

Main Methods:

  • Comprehensive literature search of MEDLINE and EMBASE databases up to July 2018.
  • Inclusion of prospective and retrospective cohort studies evaluating previous CABG status and TAVR mortality.
  • Meta-analysis using the random-effects model to pool risk ratios and 95% confidence intervals.

Main Results:

  • Eleven cohort studies involving 7299 patients (1890 with previous CABG) were analyzed.
  • Previous CABG was not significantly associated with all-cause mortality (RR 0.96, 95% CI 0.80-1.16).
  • Previous CABG was not significantly associated with cardiovascular mortality (RR 1.23, 95% CI 0.64-2.39).

Conclusions:

  • Previous CABG does not increase all-cause or cardiovascular mortality risk in patients undergoing TAVR for severe AS.
  • Transcatheter aortic valve replacement (TAVR) is a viable treatment option for severe AS patients, irrespective of prior CABG.
  • Findings support considering TAVR as an alternative or first-line therapy for severe AS patients with a history of CABG.

Keywords:
Coronary artery bypassmeta-analysismortalitysystematic reviewstranscatheter aortic valve replacement

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