Background: Patients with previous coronary artery bypass grafting (CABG), are considered to be at increased peri-operative risk when undergoing redo cardiac operations. In the era of transcatheter aortic valve implantation (TAVI), these patients constitute a considerable portion of patients with severe aortic stenosis referred for TAVI. We evaluated the impact of previous CABG on TAVI outcomes.
Methods: Patients with severe symptomatic aortic stenosis (AS) (n=380) that underwent TAVI were divided according to the presence of prior personal history of CABG. We excluded 8 patients with prior valvular surgery from analysis. TAVI clinical endpoints and adverse events were considered according to the Valve Academic Research Consortium 2 (VARC-2) definitions. Survival was estimated using Cox regression models at the enter mode with the dependant variable defined as all-cause mortality.
Results: CABG was formerly performed among 64 patients of our 372 patient cohort (17.2%). Significant difference in baseline parameters was noted: prior CABG patients were younger (80.7 vs 83.6 years), had more cardiac and vascular co-morbidities, higher mean logistic Euroscore (33.2 vs. 22.3; p=0.001), lower ejection fraction and relatively better echocardiographic parameters of severe AS (lower gradients and larger valve area). The overall VARC-2 adjudicated endpoints did not differ. Mortality at 30-days, 6 months and 1 year after TAVI was insignificantly higher among prior CABG patients, as was the overall mortality during the study follow-up period (HR=1.78; p=0.19, Cox regression).
Conclusions: Patients elected for TAVI due to prior CABG are a significantly distinct group compared to the total TAVI population. Nonetheless, we observed no increased risk of peri-procedural complications or mortality, despite a non-significant lower cumulative survival in TAVI patients after prior CABG.
