John V Conte1, Thomas G Gleason2, Jon R Resar3, David H Adams4, G Michael Deeb5, Jeffrey J Popma6, G Chad Hughes7, George L Zorn8, Michael J Reardon9. 1. Department of Surgery, The Johns Hopkins University, Baltimore, Maryland. Electronic address: jconte@jhmi.edu. 2. Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 3. Department of Medicine, The Johns Hopkins University, Baltimore, Maryland. 4. Department of Surgery, Mount Sinai Medical Center, New York, New York. 5. Department of Surgery, University of Michigan, Ann Arbor, Michigan. 6. Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts. 7. Department of Surgery, Duke University, Durham, North Carolina. 8. Department of Surgery, University of Kansas, Lawrence, Kansas. 9. Department of Surgery, Houston-Methodist DeBakey Heart and Vascular Center, Houston, Texas.
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.
RCT Entities:
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.
Authors: James D Dormer; Fiaz Islam Bhuiyan; Nahian Rahman; Nancy Deaton; Jun Sheng; Muralidhar Padala; Jaydev P Desai; Baowei Fei Journal: Proc SPIE Int Soc Opt Eng Date: 2020-03-16
Authors: Michael J Reardon; Robin H Heijmen; Nicolas M Van Mieghem; Mathew R Williams; Steven J Yakubov; Daniel Watson; Neal S Kleiman; John Conte; Atul Chawla; David Hockmuth; George Petrossian; Newell Robinson; A Pieter Kappetein; Shuzhen Li; Jeffrey J Popma Journal: JAMA Cardiol Date: 2019-08-01 Impact factor: 14.676
Authors: Sharaf-Eldin Shehada; Yacine Elhmidi; Öznur Öztürk; Markus Kasel; Antonio H Frangieh; Fanar Mourad; Jaroslav Benedik; Jaafar El Bahi; Mohamed El Gabry; Matthias Thielmann; Heinz Jakob; Daniel Wendt Journal: Cardiol Res Pract Date: 2018-04-05 Impact factor: 1.866