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Published on: May 21, 2017
Surgical versus transcatheter aortic valve replacement in patients with prior coronary artery bypass graft surgery
Esteban Aguayo1, Oh Jin Kwon1, Joseph Song1
1Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.
Insights
Transcatheter aortic valve replacement (TAVR) shows better outcomes than surgical aortic valve replacement (SAVR) for patients with prior coronary artery bypass graft surgery. TAVR resulted in lower mortality, fewer complications, and reduced costs, making it a preferred option.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Health Services Research
Background:
- Rising prevalence of aortic stenosis, particularly in an aging population.
- Increasing number of patients with prior coronary artery bypass graft (CABG) surgery undergoing aortic valve replacement.
- Need to compare outcomes of TAVR versus SAVR in this specific patient subgroup.
Purpose of the Study:
- To compare the acute outcomes of transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR).
- To evaluate TAVR vs. SAVR in patients with a history of coronary artery bypass graft (CABG) surgery.
- To analyze in-hospital mortality, postoperative complications, costs, length of stay, and readmissions.
Main Methods:
- Analysis of the 2016-2021 Nationwide Readmissions Database.
- Inclusion of adult patients (≥18 years) with prior CABG undergoing TAVR or SAVR.
- Exclusion of patients with concomitant cardiac procedures; multivariable regression models used for outcome assessment.
Main Results:
- TAVR was associated with significantly reduced odds of in-hospital mortality (aOR 0.22) and fewer respiratory (aOR 0.37) and renal (aOR 0.50) complications compared to SAVR.
- TAVR patients experienced shorter hospital stays (-2.7 days) and lower costs (-$32,000) versus SAVR patients.
- No significant difference was observed in 30-day nonelective readmissions between TAVR and SAVR groups (aOR 0.68).
Conclusions:
- Transcatheter aortic valve replacement (TAVR) demonstrates superior acute outcomes compared to surgical aortic valve replacement (SAVR) in patients with prior coronary artery bypass graft (CABG) surgery.
- TAVR is associated with lower mortality, fewer complications, and reduced healthcare costs in this population.
- Findings support TAVR as a favorable treatment option for aortic stenosis in patients with a history of CABG.
Background:
With the aging US population and improvements in diagnostics, the prevalence of aortic stenosis is rising, including among patients with prior coronary artery bypass graft surgery. This study examined acute outcomes of transcatheter aortic valve replacement versus surgical aortic valve replacement in a national cohort of patients with prior coronary artery bypass graft surgery.
Methods:
Using the 2016-2021 Nationwide Readmissions Database, we identified adult patients (≥18 years old) with prior coronary artery bypass graft surgery undergoing transcatheter or surgical aortic valve replacement. Patients with concomitant cardiac procedures were excluded. Outcomes included in-hospital mortality, postoperative complications, hospitalization costs, length of stay, and 30-day nonelective readmissions. Multivariable regression models were employed to evaluate associations.
Results:
Among an estimated 566,705 patients, 3.0% of surgical aortic valve replacement recipients and 10.4% of transcatheter aortic valve replacement recipients had prior coronary artery bypass graft surgery. Use of surgical aortic valve replacement declined from 1,347 cases in 2016 to 593 cases in 2021, whereas transcatheter procedures increased from 8,464 to 10,821 cases (both Cuzick's test for trends < .001). After multivariable adjustment and surgical aortic valve replacement as reference, transcatheter aortic valve replacement was associated with reduced odds of in-hospital mortality (adjusted odds ratio 0.22, 95% confidence interval 0.10-0.46) and intraoperative (adjusted odds ratio 0.46, 95% confidence interval 0.24-0.89), respiratory (adjusted odds ratio 0.37, 95% confidence interval 0.26-0.53), and renal (adjusted odds ratio 0.50, 95% confidence interval 0.33-0.75) complications, along with shorter hospital length of stay (-2.7 days, 95% confidence interval -3.1 to -2.2 days) and lower costs (-$32,000, 95% confidence interval -$62,000 to -$180). No significant differences in 30-day readmissions were noted (adjusted odds ratio 0.68, 95% confidence interval 0.42-1.10).
Conclusion:
Transcatheter aortic valve replacement offers lower mortality, fewer complications, and reduced costs compared with surgical aortic valve replacement, supporting its role as a favorable treatment for aortic stenosis in patients with prior coronary artery bypass graft surgery.
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