Tanush Gupta1, Sahil Khera1, Dhaval Kolte1, Kashish Goel1, Ankur Kalra1, Pedro A Villablanca1, Herbert D Aronow1, J Dawn Abbott1, Gregg C Fonarow1, Cynthia C Taub1, Neal S Kleiman1, Giora Weisz1, Ignacio Inglessis1, Sammy Elmariah1, Charanjit S Rihal1, Mario J Garcia1, Deepak L Bhatt2. 1. From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., C.C.T., G.W., M.J.G.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K., I.I., S.E.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.,); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Division of Cardiovascular Medicine, Case Western Reserve University School of Medicine, Cleveland, OH (A.K.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, TX (N.S.K.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.). 2. From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., C.C.T., G.W., M.J.G.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K., I.I., S.E.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.,); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Division of Cardiovascular Medicine, Case Western Reserve University School of Medicine, Cleveland, OH (A.K.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, TX (N.S.K.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.). dlbhattmd@post.harvard.edu.
Abstract
BACKGROUND: A significant proportion of patients requiring aortic valve replacement (AVR) have undergone prior coronary artery bypass grafting (CABG). Reoperative heart surgery is associated with increased risk. Data on relative utilization and comparative outcomes of transcatheter (TAVR) versus surgical AVR (SAVR) in patients with prior CABG are limited. METHODS AND RESULTS: We queried the 2012 to 2014 National Inpatient Sample databases to identify isolated AVR hospitalizations in adults with prior CABG. In-hospital outcomes of TAVR versus SAVR were compared using propensity-matched analysis. Of 147 395 AVRs, 15 055 (10.2%) were in patients with prior CABG. The number of TAVRs in patients with prior CABG increased from 1615 in 2012 to 4400 in 2014, whereas the number of SAVRs decreased from 2285 to 1895 (Ptrend<0.001). There were 3880 records in each group in the matched cohort. Compared with SAVR, TAVR was associated with similar in-hospital mortality (2.3% versus 2.4%; P=0.71) but lower incidence of myocardial infarction (1.5% versus 3.4%; P<0.001), stroke (1.4% versus 2.7%; P<0.001), bleeding complications (10.6% versus 24.6%; P<0.001), and acute kidney injury (16.2% versus 19.3%; P<0.001). Requirement for prior permanent pacemaker was higher in the TAVR cohort, whereas the incidence of vascular complications and acute kidney injury requiring dialysis was similar in the 2 groups. Average length of stay was shorter in patients undergoing TAVR. CONCLUSIONS: TAVR is being increasingly used as the preferred modality of AVR in patients with prior CABG. Compared with SAVR, TAVR is associated with similar in-hospital mortality but lower rates of in-hospital complications in this important subset of patients.
BACKGROUND: A significant proportion of patients requiring aortic valve replacement (AVR) have undergone prior coronary artery bypass grafting (CABG). Reoperative heart surgery is associated with increased risk. Data on relative utilization and comparative outcomes of transcatheter (TAVR) versus surgical AVR (SAVR) in patients with prior CABG are limited. METHODS AND RESULTS: We queried the 2012 to 2014 National Inpatient Sample databases to identify isolated AVR hospitalizations in adults with prior CABG. In-hospital outcomes of TAVR versus SAVR were compared using propensity-matched analysis. Of 147 395 AVRs, 15 055 (10.2%) were in patients with prior CABG. The number of TAVRs in patients with prior CABG increased from 1615 in 2012 to 4400 in 2014, whereas the number of SAVRs decreased from 2285 to 1895 (Ptrend<0.001). There were 3880 records in each group in the matched cohort. Compared with SAVR, TAVR was associated with similar in-hospital mortality (2.3% versus 2.4%; P=0.71) but lower incidence of myocardial infarction (1.5% versus 3.4%; P<0.001), stroke (1.4% versus 2.7%; P<0.001), bleeding complications (10.6% versus 24.6%; P<0.001), and acute kidney injury (16.2% versus 19.3%; P<0.001). Requirement for prior permanent pacemaker was higher in the TAVR cohort, whereas the incidence of vascular complications and acute kidney injury requiring dialysis was similar in the 2 groups. Average length of stay was shorter in patients undergoing TAVR. CONCLUSIONS: TAVR is being increasingly used as the preferred modality of AVR in patients with prior CABG. Compared with SAVR, TAVR is associated with similar in-hospital mortality but lower rates of in-hospital complications in this important subset of patients.
Authors: Dagmar F Hernandez-Suarez; Sagar Ranka; Pedro Villablanca; Nicole Yordan-Lopez; Lorena González-Sepúlveda; Jose Wiley; Cristina Sanina; Abiel Roche-Lima; Brenda G Nieves-Rodriguez; Stacey Thomas; Pedro Cox-Alomar; Angel Lopez-Candales; Harish Ramakrishna Journal: Cardiovasc Revasc Med Date: 2019-04-09
Authors: Andrew M Goldsweig; Hyo Jung Tak; Li-Wu Chen; Herbert D Aronow; Binita Shah; Dhaval S Kolte; Poonam Velagapudi; Nihar Desai; Molly Szerlip; J Dawn Abbott Journal: Am J Cardiol Date: 2019-06-07 Impact factor: 2.778
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: Dagmar F Hernandez-Suarez; Sagar Ranka; Yeunjung Kim; Azeem Latib; Jose Wiley; Angel Lopez-Candales; Duane S Pinto; Maday C Gonzalez; Harish Ramakrishna; Cristina Sanina; Brenda G Nieves-Rodriguez; Jovaniel Rodriguez-Maldonado; Roberto Feliu Maldonado; Israel J Rodriguez-Ruiz; Istoni da Luz Sant'Ana; Karlo A Wiley; Pedro Cox-Alomar; Pedro A Villablanca; Abiel Roche-Lima Journal: Cardiovasc Revasc Med Date: 2020-06-15
Authors: Ernest Spitzer; Ben Ren; Herbert Kroon; Lennart van Gils; Olivier Manintveld; Joost Daemen; Felix Zijlstra; Peter P de Jaegere; Marcel L Geleijnse; Nicolas M Van Mieghem Journal: Front Cardiovasc Med Date: 2018-08-17
Authors: Muhammad S Panhwar; Mahazarin Ginwalla; Ankur Kalra; Tanush Gupta; Dhaval Kolte; Sahil Khera; Deepak L Bhatt; Joseph F Sabik Journal: J Am Heart Assoc Date: 2019-09-19 Impact factor: 5.501