TY - JOUR
T1 - Transcatheter versus surgical aortic valve replacement in patients with prior coronary artery bypass graft operation
T2 - A PARTNER trial subgroup analysis
AU - Greason, Kevin L.
AU - Mathew, Verghese
AU - Suri, Rakesh M.
AU - Holmes, David R.
AU - Rihal, Charanjit S.
AU - McAndrew, Tom
AU - Xu, Ke
AU - Mack, Michael
AU - Webb, John G.
AU - Pichard, Augusto
AU - Williams, Mathew
AU - Leon, Martin B.
AU - Svensson, Lars
AU - Thourani, Vinod
AU - Smith, Craig R.
PY - 2014/7
Y1 - 2014/7
N2 - Background The Placement of Aortic Transcatheter Valves (PARTNER) trial reported a reduced rate of mortality in patients with previous coronary bypass grafting (CABG) operation who received surgical aortic valve replacement (SAVR) in comparison with transcatheter aortic valve replacement (TAVR). We sought to further evaluate these groups. Methods We reviewed the database of the 699 patients enrolled in the PARTNER trial. The cohort for this study consisted of 288 patients (41.2%) who had a history of CABG operation before enrollment in the PARTNER trial. All patients were followed up for 2 years. Results The mean age was 81.5 ± 6.6 years, and 231 patients (80.2%) were men. The preoperative characteristics were similar in 140 patients (48.6%) who received SAVR and 148 (51.4%) who received TAVR. There were no differences between the two groups with respect to the operative outcomes of death, stroke, and myocardial infarction, but the TAVR patients experienced more paravalvular regurgitation (p < 0.0001). At 2 years, there was a trend toward greater all-cause mortality in the TAVR patients (hazard ratio [HR] 1.53; 95% confidence interval [CI]: 0.99, 2.35; p = 0.052). Furthermore, the TAVR patients had more repeated hospitalization (HR 1.75; 95% CI: 0.99, 3.07; p = 0.05), death of any cause or repeated hospitalization (HR 1.52; 95% CI: 1.06, 2.19; p = 0.02), and death of any cause or stroke (HR 1.51; 95% CI: 1.00, 2.27; p = 0.05). Conclusions The 2-year follow-up of patients with a history of previous CABG operation in the PARTNER trial demonstrated improved outcomes with SAVR in comparison with TAVR. Further longitudinal assessment is necessary to corroborate these findings and to understand the possible causes.
AB - Background The Placement of Aortic Transcatheter Valves (PARTNER) trial reported a reduced rate of mortality in patients with previous coronary bypass grafting (CABG) operation who received surgical aortic valve replacement (SAVR) in comparison with transcatheter aortic valve replacement (TAVR). We sought to further evaluate these groups. Methods We reviewed the database of the 699 patients enrolled in the PARTNER trial. The cohort for this study consisted of 288 patients (41.2%) who had a history of CABG operation before enrollment in the PARTNER trial. All patients were followed up for 2 years. Results The mean age was 81.5 ± 6.6 years, and 231 patients (80.2%) were men. The preoperative characteristics were similar in 140 patients (48.6%) who received SAVR and 148 (51.4%) who received TAVR. There were no differences between the two groups with respect to the operative outcomes of death, stroke, and myocardial infarction, but the TAVR patients experienced more paravalvular regurgitation (p < 0.0001). At 2 years, there was a trend toward greater all-cause mortality in the TAVR patients (hazard ratio [HR] 1.53; 95% confidence interval [CI]: 0.99, 2.35; p = 0.052). Furthermore, the TAVR patients had more repeated hospitalization (HR 1.75; 95% CI: 0.99, 3.07; p = 0.05), death of any cause or repeated hospitalization (HR 1.52; 95% CI: 1.06, 2.19; p = 0.02), and death of any cause or stroke (HR 1.51; 95% CI: 1.00, 2.27; p = 0.05). Conclusions The 2-year follow-up of patients with a history of previous CABG operation in the PARTNER trial demonstrated improved outcomes with SAVR in comparison with TAVR. Further longitudinal assessment is necessary to corroborate these findings and to understand the possible causes.
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U2 - 10.1016/j.athoracsur.2014.02.079
DO - 10.1016/j.athoracsur.2014.02.079
M3 - Article
C2 - 24881859
AN - SCOPUS:84903883448
SN - 0003-4975
VL - 98
SP - 1
EP - 8
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 1
ER -