Transapical aortic valve implantation in patients with previous cardiac surgery.
BACKGROUND
This study compared surgical outcomes of patients with previous cardiac surgery undergoing transapical transcatheter aortic valve implantation (PCS-TA-TAVI) with those of patients undergoing transapical transcatheter aortic valve implantation as an initial procedure (initial TA-TAVI) by using propensity analysis.


METHODS
From January 2005 through January 2013, 267 consecutive high-risk patients underwent transapical transcatheter aortic valve implantation using a pericardial xenograft fixed within a stainless steel, balloon-expandable stent (Edwards SAPIEN). Of these, 59 patients underwent PCS-TA-TAVI (coronary artery bypass grafting: n = 31; valve surgery: n = 28), and the remaining 208 had an initial TA-TAVI procedure. Logistic regression analysis was used to identify covariates among 10 baseline patient variables. Using the significant regression coefficients, each patient's propensity score was calculated, allowing selectively matched subgroups of 45 patients in the two groups. Operative outcomes were analyzed for differences. Follow-up was 4 ± 2 years and 100% complete.


RESULTS
There was no significant difference between PCS-TA-TAVI and initial TA-TAVI patients in operative time, postoperative bleeding, 30-day survival (91% versus 93%), and survival at late follow-up (63% versus 68%; p ≥ 0.28). Overall incidence of early stroke was low with 0% for the PCS-TA-TAVI and 4% for initial TA-TAVI group (p = 0.56). Transapical transcatheter aortic valve implantation was successfully performed in all but 1 patient from the initial TA-TAVI group who required conversion to sternotomy.


CONCLUSIONS
Transapical transcatheter aortic valve implantation has simplified surgical treatment of high-risk patients with previous cardiac surgery and severe aortic valve stenosis and is associated with minimal risk of stroke. Furthermore, current data suggest that the presence of previous cardiac surgery does not impair outcomes after transapical transcatheter aortic valve implantation, making this subset of patients particularly applicable for this evolving approach.
Division of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University, Frankfurt am Main, Germany. Electronic address: nestoras.papadopoulos@kgu.de.
Nestoras
N
Papadopoulos
Division of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University, Frankfurt am Main, Germany.
Pamela
P
Ilioska
Division of Cardiology, Johann-Wolfgang-Goethe University, Frankfurt am Main, Germany.
Stephan
S
Fichtlscherer
Division of Cardiology, Johann-Wolfgang-Goethe University, Frankfurt am Main, Germany.
Ralf
R
Lehmann
Division of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University, Frankfurt am Main, Germany.
Andres
A
Beiras Fernandez
Division of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University, Frankfurt am Main, Germany.
Anton
A
Moritz
Division of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University, Frankfurt am Main, Germany.
Mirko
M
Doss
Division of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University, Frankfurt am Main, Germany.
Andreas
A
Zierer
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods* / Q000401:mortality; D006348:Cardiac Surgical Procedures / Q000379:methods / Q000401:mortality; D015331:Cohort Studies; D003287:Contrast Media; D001026:Coronary Artery Bypass / Q000379:methods; D057510:Endovascular Procedures / Q000379:methods* / Q000401:mortality; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000401:mortality; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011829:Radiation Dosage; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome; D014463:Ultrasonography
D003287:Contrast Media
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