Author + information
- Nestoras Papadopoulos1,
- Nina Schiller1,
- Andres Beiras Fernandez1,
- Stephan Fichtelscherer2,
- Ralph Lehmann2,
- Ullrich Stock1,
- Anton Moritz1,
- Mirko Doss1 and
- Andreas Zierer1
The aim of this study was to compare surgical outcome of patients with previous cardiac surgery undergoing transapical aortic valve implantation (Redo-TAVI) to those undergoing classic aortic valve replacement (Redo-AVR) by using propensity analysis.
TAVI has been suggested as an alternative to surgery in elderly patients considered inoperable or high risk for surgical aortic valve replacement.
From January 2005 through Mai 2012, 52 high risk patients underwent Redo-TAVI using a pericardial xenograft fixed within a stainless steel, balloon-expandable stent (Edwards SAPIENTM). During the same period of time 167 patients underwent classic Redo-SAVR. Logistic regression analysis was used to identify covariates among 10 baseline patient variables including the type of initial surgery. Using the significant regression coefficients, each patient's propensity score was calculated, allowing selectively matched subgroups of 40 patients each. Initial surgery included CABG in 29 patients and valve surgery in 11 patients in each group. Operative outcomes were analyzed for differences. Follow-up was 4±2 years and 100% complete.
Postoperative chest tube drainage (163±214 vs 562±332 ml/24h, p: 0.024), incidence of permanent postoperative neurologic events (0 vs 13%, p: 0.012) and 30 day mortality (10 vs 20%, p: 0.046) was lower in patients with Redo-TAVI as compared to Redo-AVR. There was a trend towards a decreased ventilation time and need of transfusion of packed red blood cell concentrates in the Redo-TAVI group (p: 0.078). One patient in the Redo-TAVI group required temporary cardiopulmonary bypass support. During late follow up there was no significant difference regarding mortality (10 vs 13%) and incidence of stroke (0 vs 3%, p:0.11).
Despite the limited number of patients, current data suggest a faster postoperative recovery and reduced perioperative morbidity and mortality with Redo-TAVI as compared to classic Redo-AVR. This evolving approach has reduced surgical trauma and may be particularly applicable to elderly high risk patients with previous cardiac surgery.
- 2013 American College of Cardiology Foundation