Transcatheter or surgical aortic valve replacement in patients with prior coronary artery bypass grafting

John V. Conte, Thomas G. Gleason, Jon R. Resar, David H. Adams, G. Michael Deeb, Jeffrey J. Popma, G. Chad Hughes, George L. Zorn, Michael J. Reardon

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background Transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) are treatment options for aortic stenosis in patients with prior coronary artery bypass graft surgery. We assessed the major clinical outcomes of such patients enrolled in the CoreValve High Risk (CHR) study. Methods Of the 795 CHR study patients, 226 had prior coronary artery bypass graft surgery; 115 underwent TAVR and 111 underwent SAVR. The primary endpoint was a comparison of all-cause mortality at 1 year. Important secondary clinical endpoints were assessed. Results At 1 year, all-cause mortality was 9.6% for TAVR versus 18.1% for SAVR (p = 0.06); cardiovascular mortality was 7.0% for TAVR versus 13.8% for SAVR (p = 0.09). A combination of The Society of Thoracic Surgeons risk score greater than 7 and age greater than 80 years was a significant predictor of mortality, with TAVR demonstrating a survival advantage (p = 0.03). No differences were seen for stroke. The SAVR group had longer intensive care unit and hospital stays, increased incidence of acute kidney injury, life-threatening or disabling bleeding, and major adverse cardiac and cerebrovascular events (p < 0.05). Pacemaker implantation and paravalvular regurgitation were greater with TAVR at all timepoints. Conclusions For patients with prior coronary artery bypass graft surgery and aortic stenosis, TAVR offers a significant morbidity advantage and a strong trend toward improved survival over SAVR at 1 year.

Original languageEnglish (US)
Pages (from-to)72-79
Number of pages8
JournalAnnals of Thoracic Surgery
Volume101
Issue number1
DOIs
StatePublished - Jan 1 2016

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Aortic Valve
Surgical Instruments
Coronary Artery Bypass
Mortality
Aortic Valve Stenosis
Transplants
Survival
Transcatheter Aortic Valve Replacement
Acute Kidney Injury
Intensive Care Units
Length of Stay
Stroke
Hemorrhage
Morbidity
Incidence

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Conte, John V. ; Gleason, Thomas G. ; Resar, Jon R. ; Adams, David H. ; Deeb, G. Michael ; Popma, Jeffrey J. ; Chad Hughes, G. ; Zorn, George L. ; Reardon, Michael J. / Transcatheter or surgical aortic valve replacement in patients with prior coronary artery bypass grafting. In: Annals of Thoracic Surgery. 2016 ; Vol. 101, No. 1. pp. 72-79.
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abstract = "Background Transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) are treatment options for aortic stenosis in patients with prior coronary artery bypass graft surgery. We assessed the major clinical outcomes of such patients enrolled in the CoreValve High Risk (CHR) study. Methods Of the 795 CHR study patients, 226 had prior coronary artery bypass graft surgery; 115 underwent TAVR and 111 underwent SAVR. The primary endpoint was a comparison of all-cause mortality at 1 year. Important secondary clinical endpoints were assessed. Results At 1 year, all-cause mortality was 9.6{\%} for TAVR versus 18.1{\%} for SAVR (p = 0.06); cardiovascular mortality was 7.0{\%} for TAVR versus 13.8{\%} for SAVR (p = 0.09). A combination of The Society of Thoracic Surgeons risk score greater than 7 and age greater than 80 years was a significant predictor of mortality, with TAVR demonstrating a survival advantage (p = 0.03). No differences were seen for stroke. The SAVR group had longer intensive care unit and hospital stays, increased incidence of acute kidney injury, life-threatening or disabling bleeding, and major adverse cardiac and cerebrovascular events (p < 0.05). Pacemaker implantation and paravalvular regurgitation were greater with TAVR at all timepoints. Conclusions For patients with prior coronary artery bypass graft surgery and aortic stenosis, TAVR offers a significant morbidity advantage and a strong trend toward improved survival over SAVR at 1 year.",
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Conte, JV, Gleason, TG, Resar, JR, Adams, DH, Deeb, GM, Popma, JJ, Chad Hughes, G, Zorn, GL & Reardon, MJ 2016, 'Transcatheter or surgical aortic valve replacement in patients with prior coronary artery bypass grafting', Annals of Thoracic Surgery, vol. 101, no. 1, pp. 72-79. https://doi.org/10.1016/j.athoracsur.2015.06.067

Transcatheter or surgical aortic valve replacement in patients with prior coronary artery bypass grafting. / Conte, John V.; Gleason, Thomas G.; Resar, Jon R.; Adams, David H.; Deeb, G. Michael; Popma, Jeffrey J.; Chad Hughes, G.; Zorn, George L.; Reardon, Michael J.

In: Annals of Thoracic Surgery, Vol. 101, No. 1, 01.01.2016, p. 72-79.

Research output: Contribution to journalArticle

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T1 - Transcatheter or surgical aortic valve replacement in patients with prior coronary artery bypass grafting

AU - Conte, John V.

AU - Gleason, Thomas G.

AU - Resar, Jon R.

AU - Adams, David H.

AU - Deeb, G. Michael

AU - Popma, Jeffrey J.

AU - Chad Hughes, G.

AU - Zorn, George L.

AU - Reardon, Michael J.

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N2 - Background Transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) are treatment options for aortic stenosis in patients with prior coronary artery bypass graft surgery. We assessed the major clinical outcomes of such patients enrolled in the CoreValve High Risk (CHR) study. Methods Of the 795 CHR study patients, 226 had prior coronary artery bypass graft surgery; 115 underwent TAVR and 111 underwent SAVR. The primary endpoint was a comparison of all-cause mortality at 1 year. Important secondary clinical endpoints were assessed. Results At 1 year, all-cause mortality was 9.6% for TAVR versus 18.1% for SAVR (p = 0.06); cardiovascular mortality was 7.0% for TAVR versus 13.8% for SAVR (p = 0.09). A combination of The Society of Thoracic Surgeons risk score greater than 7 and age greater than 80 years was a significant predictor of mortality, with TAVR demonstrating a survival advantage (p = 0.03). No differences were seen for stroke. The SAVR group had longer intensive care unit and hospital stays, increased incidence of acute kidney injury, life-threatening or disabling bleeding, and major adverse cardiac and cerebrovascular events (p < 0.05). Pacemaker implantation and paravalvular regurgitation were greater with TAVR at all timepoints. Conclusions For patients with prior coronary artery bypass graft surgery and aortic stenosis, TAVR offers a significant morbidity advantage and a strong trend toward improved survival over SAVR at 1 year.

AB - Background Transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) are treatment options for aortic stenosis in patients with prior coronary artery bypass graft surgery. We assessed the major clinical outcomes of such patients enrolled in the CoreValve High Risk (CHR) study. Methods Of the 795 CHR study patients, 226 had prior coronary artery bypass graft surgery; 115 underwent TAVR and 111 underwent SAVR. The primary endpoint was a comparison of all-cause mortality at 1 year. Important secondary clinical endpoints were assessed. Results At 1 year, all-cause mortality was 9.6% for TAVR versus 18.1% for SAVR (p = 0.06); cardiovascular mortality was 7.0% for TAVR versus 13.8% for SAVR (p = 0.09). A combination of The Society of Thoracic Surgeons risk score greater than 7 and age greater than 80 years was a significant predictor of mortality, with TAVR demonstrating a survival advantage (p = 0.03). No differences were seen for stroke. The SAVR group had longer intensive care unit and hospital stays, increased incidence of acute kidney injury, life-threatening or disabling bleeding, and major adverse cardiac and cerebrovascular events (p < 0.05). Pacemaker implantation and paravalvular regurgitation were greater with TAVR at all timepoints. Conclusions For patients with prior coronary artery bypass graft surgery and aortic stenosis, TAVR offers a significant morbidity advantage and a strong trend toward improved survival over SAVR at 1 year.

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