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Original Articles: Adult Cardiac

Transcatheter Aortic Valve Implantation or Surgical Aortic Valve Replacement as Redo Procedure After Prior Coronary Artery Bypass Grafting

^a Department of Cardiology, Swiss Cardiovascular Center, University Hospital Berne, University of Berne, Berne, Switzerland
^b Department of Cardiovascular Surgery, Swiss Cardiovascular Center, University Hospital Berne, University of Berne, Berne, Switzerland

Accepted for publication May 27, 2011.

^_* Address correspondence to Dr Wenaweser, Swiss Cardiovascular Center, University Hospital Berne, Freiburgstrasse, CH-3010 Berne, Switzerland (Email: peter.wenaweser{at}insel.ch).

Presented at the Forty-seventh Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 31–Feb 2, 2011.

Background: The perioperative risk for redo surgical aortic valve replacement (S-AVR) in patients with severe aortic stenosis and prior coronary artery bypass grafting (CABG) is increased. Transcatheter aortic valve implantation (TAVI) represents an alternative. We assessed the perioperative and mid-term clinical outcome of patients undergoing S-AVR or TAVI.

Methods: In a retrospective observational, comparative study, 40 consecutive patients underwent redo operation with S-AVR or TAVI between April 2005 and April 2010. Median sternotomy and extracorporeal circulation were used for S-AVR; TAVI access was transfemoral (n = 27; 67.5%), transapical (n = 11; 27.5%), or transsubclavian (n = 2; 5.0%). Clinical and echocardiographic follow-up was at 30 days and 6 months.

Results: TAVI patients were older (78.5 ± 6 vs 70.6 ± 8 years, p < 0.001) and presented higher logistic (33.5 ± 17 vs 20.2 ± 14, p < 0.001) European System for Cardiac Operative Risk Evaluation scores. All-cause mortality was 2.5% in both groups and major adverse cardiac and cerebrovascular event rates were comparable (7.5% TAVI vs 17.5% S-AVR, p = 0.311) after 30 days. TAVI was associated with a higher rate of permanent pacemaker implantation (30% vs 0%, p < 0.001) and grade II residual aortic regurgitation in 14%. Incidence of cerebrovascular events was 7.5% in S-AVR vs 2.5% in TAVI (p = 0.61).

Conclusions: In elderly, high-risk patients after prior CABG, conventional aortic valve replacement and TAVI are comparable treatment options with favorable clinical outcome. A redo operation itself does not sufficiently justify a TAVI approach.

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