title: Transcatheter versus surgical aortic valve replacement in patients with prior coronary artery bypass graft operation: a PARTNER trial subgroup analysis.
abstract: BACKGROUND
  The Placement of Aortic Transcatheter Valves (PARTNER) trial reported a reduced rate of mortality in patients with previous coronary bypass grafting (CABG) operation who received surgical aortic valve replacement (SAVR) in comparison with transcatheter aortic valve replacement (TAVR). We sought to further evaluate these groups.
  
  
  METHODS
  We reviewed the database of the 699 patients enrolled in the PARTNER trial. The cohort for this study consisted of 288 patients (41.2%) who had a history of CABG operation before enrollment in the PARTNER trial. All patients were followed up for 2 years.
  
  
  RESULTS
  The mean age was 81.5±6.6 years, and 231 patients (80.2%) were men. The preoperative characteristics were similar in 140 patients (48.6%) who received SAVR and 148 (51.4%) who received TAVR. There were no differences between the two groups with respect to the operative outcomes of death, stroke, and myocardial infarction, but the TAVR patients experienced more paravalvular regurgitation (p<0.0001). At 2 years, there was a trend toward greater all-cause mortality in the TAVR patients (hazard ratio [HR] 1.53; 95% confidence interval [CI]: 0.99, 2.35; p=0.052). Furthermore, the TAVR patients had more repeated hospitalization (HR 1.75; 95% CI: 0.99, 3.07; p=0.05), death of any cause or repeated hospitalization (HR 1.52; 95% CI: 1.06, 2.19; p=0.02), and death of any cause or stroke (HR 1.51; 95% CI: 1.00, 2.27; p=0.05).
  
  
  CONCLUSIONS
  The 2-year follow-up of patients with a history of previous CABG operation in the PARTNER trial demonstrated improved outcomes with SAVR in comparison with TAVR. Further longitudinal assessment is necessary to corroborate these findings and to understand the possible causes.
authors.affiliation: Mayo Clinic, Rochester, Minnesota. Electronic address: greason.kevin@mayo.edu.
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Greason
authors.affiliation: Mayo Clinic, Rochester, Minnesota.
authors.forename: Verghese
authors.initials: V
authors.lastname: Mathew
authors.affiliation: Mayo Clinic, Rochester, Minnesota.
authors.forename: Rakesh M
authors.initials: RM
authors.lastname: Suri
authors.affiliation: Mayo Clinic, Rochester, Minnesota.
authors.forename: David R
authors.initials: DR
authors.lastname: Holmes
authors.affiliation: Mayo Clinic, Rochester, Minnesota.
authors.forename: Charanjit S
authors.initials: CS
authors.lastname: Rihal
authors.affiliation: Cardiovascular Research Foundation, New York, New York.
authors.forename: Tom
authors.initials: T
authors.lastname: McAndrew
authors.affiliation: Cardiovascular Research Foundation, New York, New York.
authors.forename: Ke
authors.initials: K
authors.lastname: Xu
authors.affiliation: Medical City, Dallas, Texas.
authors.forename: Michael
authors.initials: M
authors.lastname: Mack
authors.affiliation: University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: John G
authors.initials: JG
authors.lastname: Webb
authors.affiliation: Washington Hospital Center, Washington, District of Columbia.
authors.forename: Augusto
authors.initials: A
authors.lastname: Pichard
authors.affiliation: Columbia University Medical Center and New York Presbyterian Hospital, New York, New York.
authors.forename: Mathew
authors.initials: M
authors.lastname: Williams
authors.affiliation: Columbia University Medical Center and New York Presbyterian Hospital, New York, New York.
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.affiliation: Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Lars
authors.initials: L
authors.lastname: Svensson
authors.affiliation: Emory University, Atlanta, Georgia.
authors.forename: Vinod
authors.initials: V
authors.lastname: Thourani
authors.affiliation: Columbia University Medical Center and New York Presbyterian Hospital, New York, New York.
authors.forename: Craig R
authors.initials: CR
authors.lastname: Smith
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods*; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology