title: Early and mid-term outcomes in patients undergoing transcatheter aortic valve implantation after previous coronary artery bypass grafting.
abstract: OBJECTIVE
  Surgical aortic valve replacement in patients with previous coronary artery bypass grafting (CABG) carries a high mortality. Transcatheter aortic valve implantation (TAVI) has been shown to be successful in high risk subgroups of patients. Our goal is therefore to evaluate the impact of a history of CABG on the outcome of patients who undergo TAVI.
  
  
  METHODS
  From October 2006 to June 2010, among the 201 patients selected to undergo TAVI, 54 (27%) had a history of CABG. Outcomes were prospectively collected.
  
  
  RESULTS
  The 30-day outcome was not different between patients with previous CABG vs. those without, in particular as regards mortality (respectively, 5.6% vs. 10.9%; P = 0.25). Mid-term survival (mean FU: 7 ± 9 months) was not different at 2 years between patients with previous CABG vs. patients without (65.7 ± 6.2% vs. 80.0 ± 7.7% respectively; P = 0.12). In multivariate analysis, CABG was not associated with an excess mid-term mortality after TAVI.
  
  
  CONCLUSIONS
  Previous CABG does not adversely affect outcome in patients undergoing TAVI. If confirmed by larger prospective series and ideally by a randomized trial comparing CABG vs. redo surgery, this observation might lead the heart team to consider TAVI as an attractive option in the population of high risk patients with aortic stenosis and previous CABG.
authors.affiliation: Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Paris, France. gregory.ducrocq@bch.aphp.fr
authors.forename: Gregory
authors.initials: G
authors.lastname: Ducrocq
authors.forename: Nawwar
authors.initials: N
authors.lastname: Al-Attar
authors.forename: Dominique
authors.initials: D
authors.lastname: Himbert
authors.forename: David
authors.initials: D
authors.lastname: Messika-Zeitoun
authors.forename: Bernard
authors.initials: B
authors.lastname: Iung
authors.forename: Fleur
authors.initials: F
authors.lastname: Descoutures
authors.forename: Patrick
authors.initials: P
authors.lastname: Nataf
authors.forename: Alec
authors.initials: A
authors.lastname: Vahanian
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D004812:Epidemiologic Methods; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome; D014463:Ultrasonography