3
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Voudris KV, Wong SC, Kaple R, Kampaktsis PN, de Biasi AR, Weiss JS, Devereux R, Krieger K, Kim L, Swaminathan RV, Feldman DN, Singh H, Skubas NJ, Minutello RM, Bergman G, Salemi A. Transapical transcatheter aortic valve replacement in patients with or without prior coronary artery bypass graft operation. J Cardiothorac Surg 2016; 11:158. [PMID: 27899140 PMCID: PMC5129212 DOI: 10.1186/s13019-016-0551-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 11/23/2016] [Indexed: 11/10/2022] Open
Abstract
Background Transapical approach (TA) is an established access alternative to the transfemoral technique in patients undergoing transcatheter aortic valve replacement (TAVR) for treatment of symptomatic aortic valve stenosis. The impact of prior coronary artery bypass grafting (CABG) on clinical outcomes in patients undergoing TA-TAVR is not well defined. Methods A single center retrospective cohort analysis of 126 patients (male 41%, mean age 85.8 ± 6.1 years) who underwent TA balloon expandable TAVR (Edwards SAPIEN, SAPIEN XT or SAPIEN 3) was performed. Patients were classified as having prior CABG (n = 45) or no prior CABG (n = 81). Baseline clinical characteristics, in-hospital, 30-day, 6 months and one-year clinical outcomes were compared. Results Compared to patients without prior CABG, CABG patients were more likely to be male (62.2 vs. 29.6%, p < 0.001) with a higher STS score (11.66 ± 5.47 vs. 8.99 ± 4.19, p = 0.003), history of myocardial infarction (55 vs. 21.1%, p < 0.001), implantable cardioverter defibrillator (17.8 vs. 3.7%, p = 0.017), left main coronary artery disease (42.2 vs. 4.9%, p < 0.001), and proximal left anterior descending coronary artery stenosis (57.8 vs. 16%, p < 0.001). They also presented with a lower left ventricular ejection fraction (%) (42.3 ± 15.3 vs. 54.3 ± 11.6, p < 0.01) and a larger effective valve orifice area (0.75 ± 0.20 cm2 vs. 0.67 ± 0.14 cm2, p = 0.025). There were no intra-procedural deaths, no differences in stroke (0 vs. 1.2%, p = 1.0), procedure time in hours (3.50 ± 0.80 vs. 3.26 ± 0.86, p = 0.127), re-intubation rate (8.9 vs. 8.6% p = 1.0), and renal function (highest creatinine value 1.73 ± 0.71 mg/ml vs.1.88 ± 1.15 mg/ml, p = 0.43). All-cause mortality at 6 months was similar in both groups (11.4, vs. 17.3% p = 0.44), and one-year survival was 81.8 and 77.8% respectively (p = 0.51). On multivariate analysis, the only factor significantly associated with one-year mortality was prior history of stroke (HR, 2.76; 95% CI, 1.06-7.17, p = 0.037). Conclusion Despite the higher baseline clinical risk profile, patients with history of prior CABG undergoing TA-TAVR had comparable in-hospital, 6 months and one-year clinical outcomes to those without prior CABG.
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Affiliation(s)
- Konstantinos V Voudris
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA
| | - S Chiu Wong
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.,Department of Cardiology, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA
| | - Ryan Kaple
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.,Department of Cardiology, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA
| | - Polydoros N Kampaktsis
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA
| | - Andreas R de Biasi
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.,Department of Cardiothoracic Surgery, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA
| | - Jonathan S Weiss
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.,Department of Cardiothoracic Surgery, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA
| | - Richard Devereux
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.,Department of Cardiology, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA
| | - Karl Krieger
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.,Department of Cardiothoracic Surgery, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA
| | - Luke Kim
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.,Department of Cardiology, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA
| | - Rajesh V Swaminathan
- Department of Cardiology, Duke University Medical Center and the Duke Clinical Research Institute, Durham, NC, USA
| | - Dmitriy N Feldman
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.,Department of Cardiology, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA
| | - Harsimran Singh
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.,Department of Cardiology, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA
| | - Nikolaos J Skubas
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.,Department of Anesthesiology, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA
| | - Robert M Minutello
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.,Department of Cardiology, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA
| | - Geoffrey Bergman
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.,Department of Cardiology, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA
| | - Arash Salemi
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA. .,Department of Cardiothoracic Surgery, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.
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5
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Ando T, Briasoulis A, Holmes AA, Afonso L, Schreiber T, Kondur A. Transcatheter aortic valve replacement versus surgical aortic valve replacement in patients with previous coronary artery bypass surgery: A systematic review and meta-analysis. Int J Cardiol 2016; 215:14-9. [PMID: 27104920 DOI: 10.1016/j.ijcard.2016.04.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 04/10/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Patients with severe aortic stenosis (AS) and previous coronary artery bypass graft (CABG) surgery have increased risk for aortic valve replacement. Whether surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) offers better outcomes in this population is unclear. We aimed to assess outcomes of TAVR and SAVR in patients with previous CABG. METHODS A systematic literature search of Medline, EMBASE and Cochrane library was conducted. Studies that reported clinical outcomes (perioperative or mid-term all-cause-mortality, cardiovascular mortality, pacemaker implantation, hospital duration and stroke) were included. Random-effect modeling was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Five cohort studies including a total of 872 patients (423 in TAVR, 449 in SAVR) were analyzed. STS scores were comparable between the two groups. No difference in all-cause-mortality, cardiovascular mortality and stroke at 30days, 1year and total follow-up period was seen between the two groups. TAVR patients had higher pacemaker implantation rates (OR 3.41, 95% CI 1.66-6.38, p<0.001, I(2)=21%) and shorter hospital stay (-2.63days, 95% CI -5.20 to -0.04, p=0.05, I(2)=43%). CONCLUSIONS Patients with previous CABG who underwent TAVR had similar perioperative and long-term survival while experiencing more pacemaker implantations and shorter hospital stay compared to those who had SAVR making TAVR a safe and efficacious alternative to SAVR.
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Affiliation(s)
- Tomo Ando
- Wayne State University, Detroit Medical Center, Division of Cardiology, Detroit, MI 48226, USA
| | - Alexandros Briasoulis
- Wayne State University, Detroit Medical Center, Division of Cardiology, Detroit, MI 48226, USA.
| | - Anthony A Holmes
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA
| | - Luis Afonso
- Wayne State University, Detroit Medical Center, Division of Cardiology, Detroit, MI 48226, USA
| | - Theodore Schreiber
- Wayne State University, Detroit Medical Center, Division of Cardiology, Detroit, MI 48226, USA
| | - Ashok Kondur
- Wayne State University, Detroit Medical Center, Division of Cardiology, Detroit, MI 48226, USA
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6
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Papadopoulos N, El-Sayed Ahmad A, Thudt M, Fichtlscherer S, Meybohm P, Reyher C, Moritz A, Zierer A. Successful fast track protocol implementation for patients undergoing transapical transcatheter aortic valve implantation. J Cardiothorac Surg 2016; 11:55. [PMID: 27067581 PMCID: PMC4827191 DOI: 10.1186/s13019-016-0449-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 04/04/2016] [Indexed: 11/16/2022] Open
Abstract
Background The aim of the current study is to report our experience with fast-track treatment of patients undergoing transapical transcatheter aortic valve implantation (TA-TAVI) and to determine perioperative predictors for fast-track protocol failure. Methods Being one of the pioneering centers to start performing TA-TAVI back in 2005, we routinely included patients undergoing this procedure into our fast-track management program since 2008. Between January 2008 and June 2013, 207 consecutive high-risk patients (mean age 79 ± 7 years, mean Log. EuroSCORE 24 ± 10) who underwent TA-TAVI accordingly to our institutional fast-track approach were prospectively collected and analyzed. Uni- and multivariate analysis were performed to identify independent pre- and perioperative predictors of fast-track protocol failure, defined as inability to discharge the patient from the intensive care unit (ICU) on the day of surgery or as readmission to the ICU 48 h after the initial discharge. Results Fast-track management was successful in 83 % of the patients. 30-day mortality was 8 %. Fast-track protocol failure (17 %) was associated with an outcome worsening compared to the remaining patients (mortality: 40 % vs. 2 % and mean hospital stay: 19 ± 12 vs. 10 ± 9 days; P = .002). Independent predictors of fast-track protocol failure were age ≥85 years (OR 3.1; CI 95 % 1.89–6.21), ejection fraction (EF) ≤30 % (OR 2.6; CI 95 % 1.99–7.52), moderate to severe preoperative mitral valve regurgitation (OR 2.7; CI 95 % 1.27–6.43) and fluoroscopy time ≥12 min (OR 2.9; CI 95 % 1.28–7.46). Conclusions Fast-track patient management following TA-TAVI is safe and reproducible in the majority of patients. Besides patient-related preoperative risk factors (age ≥85 years, EF ≤30 % and moderate to severe preoperative mitral valve regurgitation) a technically challenging intraoperative course as evidenced in a prolonged fluoroscopy time are independent predictors of fast-track protocol failure which is associated with high loss of patient outcome.
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Affiliation(s)
- Nestoras Papadopoulos
- Division of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University Frankfurt/Main, Theodor Stern Kai 7, 60590, Frankfurt am Main, Germany.
| | - Ali El-Sayed Ahmad
- Division of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University Frankfurt/Main, Theodor Stern Kai 7, 60590, Frankfurt am Main, Germany
| | - Marlene Thudt
- Division of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University Frankfurt/Main, Theodor Stern Kai 7, 60590, Frankfurt am Main, Germany
| | - Stephan Fichtlscherer
- Division of Cardiology, Johann-Wolfgang-Goethe University Frankfurt/Main, Frankfurt, Germany
| | - Patrick Meybohm
- Clinic of Anesthesiology, Intensive Care Medicine and Pain Therapy, Goethe-University Hospital Frankfurt/Main, Frankfurt, Germany
| | - Christian Reyher
- Clinic of Anesthesiology, Intensive Care Medicine and Pain Therapy, Goethe-University Hospital Frankfurt/Main, Frankfurt, Germany
| | - Anton Moritz
- Division of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University Frankfurt/Main, Theodor Stern Kai 7, 60590, Frankfurt am Main, Germany
| | - Andreas Zierer
- Division of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University Frankfurt/Main, Theodor Stern Kai 7, 60590, Frankfurt am Main, Germany
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9
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Biancari F, Onorati F, Mariscalco G, De Feo M, Messina A, Santarpino G, Santini F, Beghi C, Della Ratta E, Troise G, Fischlein T, Passerone G, Juvonen T, Mazzucco A, Heikkinen J, Faggian G. First-time, isolated surgical aortic valve replacement after prior coronary artery bypass surgery: results from the RECORD multicenter registry. J Card Surg 2014; 29:450-4. [PMID: 24861960 DOI: 10.1111/jocs.12365] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND This multicenter study was undertaken to determine the immediate and long-term outcomes in patients undergoing a primary surgical aortic valve replacement (AVR) who had a previous coronary artery bypass graft surgery with patent grafts. METHODS One hundred and thirteen consecutive patients (mean EuroSCORE II, 10.3 ± 7.7%, median 8.0%) who underwent first-time isolated AVR after coronary artery bypass grafting (CABG) were the subjects of this multicenter study. The procedure was performed through a full sternotomy in 95.7% of cases, a patent internal mammary artery graft was clamped in 76.6% of patients. The temperature of cardioplegia was ≤12 °C in 62.8% of patients and systemic temperature was <32 °C in 23.9% of patients. RESULTS Thirty-day mortality was 4.4%. Stroke was observed in 8.0% of patients, low cardiac output syndrome in 14.1%, prolonged tracheal intubation in 20.8%, and intensive care unit stay was longer than five days in 19.5% of patients. Among patients with a patent internal mammary graft (91 patients), clamping of this graft (5.7% vs. 0%, p = 0.57) was associated with a nonsignificant trend toward increased 30-day mortality. One-, three- and five-year survival rates were 91.5%, 90.4%, and 88.4%, respectively. CONCLUSIONS Patients undergoing isolated AVR after prior CABG have a good immediate and late survival. A history of prior CABG should not be considered an absolute indication for transcatheter AVR.
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Affiliation(s)
- Fausto Biancari
- Department of Surgery, Oulu University Hospital, Oulu, Finland
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