Comparison of midterm outcomes of transcatheter aortic valve implantation in patients with and without previous coronary artery bypass grafting

Heart Vessels. 2018 Oct;33(10):1229-1237. doi: 10.1007/s00380-018-1166-9. Epub 2018 Apr 21.

Abstract

The midterm safety and feasibility of transcatheter aortic valve implantation (TAVI) for patients with a history of coronary artery bypass graft (CABG) and high operative risk are unclear. This study compared the midterm outcomes of patients undergoing TAVI with or without previous CABG surgery. Between October 2013 and July 2016, 1,613 patients underwent TAVI according to the Optimized CathEter vAlvular iNtervention (OCEAN)-TAVI registry (previous CABG: n = 120; no previous CABG: n = 1493). The propensity score comprised the variables of the Society of Thoracic Surgeons Score, previous myocardial infarction, peripheral artery disease, chronic kidney disease > stage 2 (estimated glomerular filtration rate < 60 mL/min/1.73 m2), and the TAVI approach method. After propensity matching, 118 patients were classified into the CABG and non-CABG groups. Kaplan-Meier analysis revealed that the incidence of overall cardiovascular death in the CABG group was significantly higher than in the non-CABG group (log-rank; p = 0.004). Overall mortality due to heart failure was higher in the CABG than in the non-CABG group (8.5 vs. 1.7%, p = 0.038). The present study demonstrated that patients with a history of CABG who underwent TAVI had a higher frequency of cardiovascular death, mainly due to heart failure. Heart failure detection and rigorous heart failure management are required after TAVI.

Keywords: CABG; Congestive heart failure; Survival; TAVI.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Valve / diagnostic imaging
  • Aortic Valve / surgery*
  • Aortic Valve Stenosis / complications
  • Aortic Valve Stenosis / mortality
  • Aortic Valve Stenosis / surgery*
  • Coronary Artery Bypass*
  • Coronary Artery Disease / complications
  • Coronary Artery Disease / mortality
  • Coronary Artery Disease / surgery*
  • Feasibility Studies
  • Female
  • Fluoroscopy
  • Follow-Up Studies
  • Humans
  • Japan / epidemiology
  • Male
  • Postoperative Complications / epidemiology*
  • Propensity Score*
  • Prospective Studies
  • Registries
  • Risk Assessment / methods
  • Risk Factors
  • Time Factors
  • Transcatheter Aortic Valve Replacement*
  • Treatment Outcome