title: Results of surgical aortic valve replacement and transapical transcatheter aortic valve replacement in patients with previous coronary artery bypass grafting.
abstract: To evaluate the results of aortic valve replacement through sternotomic approach in redo scenarios (RAVR) vs transapical transcatheter aortic valve replacement (TAVR), in patients in the eighth decade of life or older already undergone previous coronary artery bypass grafting (CABG).
  
  
  
  One hundred and twenty-six patients undergoing RAVR were compared with 113 patients undergoing TaTAVR in terms of 30-day mortality and Valve Academic Research Consortium-2 outcomes. The two groups were also analysed after propensity-matching.
  
  
  
  TaTAVR patients demonstrated a higher incidence of 30-day mortality (P = 0.03), stroke (P = 0.04), major bleeding (P = 0.03), worse 'early safety' (P = 0.04) and lower permanent pacemaker implantation (P = 0.03). TaTAVR had higher follow-up hazard in all-cause mortality [hazard ratio (HR) 3.15, 95% confidence interval (CI) 1.28-6.62; P < 0.01] and cardiovascular mortality (HR 1.66, 95% CI 1.02-4.88; P = 0.04). Propensity-matched patients showed comparable 30-day outcome in terms of survival, major morbidity and early safety, with only a lower incidence of transfusions after TaTAVR (10.7% vs RAVR: 57.1%; P < 0.01). A trend towards lower Acute Kidney Injury Network Classification 2/3 (3.6% vs RAVR 21.4%; P = 0.05) and towards a lower freedom from all-cause mortality at follow-up (TaTAVR: 44.3 ± 21.3% vs RAVR: 86.6 ± 9.3%; P = .08) was demonstrated after TaTAVR, although cardiovascular mortality was comparable (TaTAVR: 86.5 ± 9.7% vs RAVR: 95.2 ± 4.6%; P = 0.52). Follow-up freedom from stroke, acute heart failure, reintervention on AVR and thrombo-embolisms were comparable (P = NS). EuroSCORE II (P = 0.02), perioperative stroke (P = 0.01) and length of hospitalization (P = 0.02) were the determinants of all-cause mortality at follow-up, whereas perioperative stroke (P = 0.03) and length of hospitalization (P = 0.04) impacted cardiovascular mortality at follow-up.
  
  
  
  Reported differences in mortality and morbidity after TaTAVR and RAVR reflect differences in baseline risk profiles. Given the lower trend for renal complications, patients at higher perioperative renal risk might be better served by TaTAVR.
authors.affiliation: Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy francesco.onorati@ospedaleuniverona.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Onorati
authors.affiliation: Division of Cardiac Surgery, University of Padua, Padova, Italy francesco.onorati@ospedaleuniverona.it.
authors.forename: Augusto
authors.initials: A
authors.lastname: D'Onofrio
authors.affiliation: Department of Cardiac Surgery, University of Oulu, Oulu, Finland.
authors.forename: Fausto
authors.initials: F
authors.lastname: Biancari
authors.affiliation: Division of Cardiac Surgery, University of Torino, Turin, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Salizzoni
authors.affiliation: Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Caserta, Italy.
authors.forename: Marisa
authors.initials: M
authors.lastname: De Feo
authors.affiliation: Division of Cardiac Surgery, Monzino Hospital, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Agrifoglio
authors.affiliation: Cardiac Surgery Unit, Insubria University, Varese, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Mariscalco
authors.affiliation: Clinica Montevergine, Avellino, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Lucchetti
authors.affiliation: Cardiac Surgery Unit, Poliambulanza Foundation, Brescia, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Messina
authors.affiliation: Department of Cardiac Surgery, San Camillo Hospital, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Musumeci
authors.affiliation: Cardiovascular Center, Klinikum Nürnberg-Paracelsus Medical University, Nuremberg, Germany.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Santarpino
authors.affiliation: Division of Cardiac Surgery, Humanitas Gavazzeni Hospital, Bergamo, Italy.
authors.forename: Giampiero
authors.initials: G
authors.lastname: Esposito
authors.affiliation: IRCCS San Martino University Hospital, Genoa, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Santini
authors.affiliation: San Bortolo Hospital, Vicenza, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Magagna
authors.affiliation: Cardiac Surgery Unit, Insubria University, Varese, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Beghi
authors.affiliation: University of Pavia, Corvino San Quirico, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Aiello
authors.affiliation: Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Caserta, Italy.
authors.forename: Ester Dalla
authors.initials: ED
authors.lastname: Ratta
authors.affiliation: Policlinico Sant'Orsola Malpighi, Bologna, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Savini
authors.affiliation: Cardiac Surgery Unit, Poliambulanza Foundation, Brescia, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Troise
authors.affiliation: Division of Cardiac Surgery, Clinica S. Maria, Bari, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Cassese
authors.affiliation: Cardiovascular Center, Klinikum Nürnberg-Paracelsus Medical University, Nuremberg, Germany.
authors.forename: Theodor
authors.initials: T
authors.lastname: Fischlein
authors.affiliation: Fondazione Monasterio, Massa, Italy.
authors.forename: Mattia
authors.initials: M
authors.lastname: Glauber
authors.affiliation: IRCCS San Martino University Hospital, Genoa, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Passerone
authors.affiliation: Ordine Mauriziano Hospital, Turin, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Punta
authors.affiliation: Department of Cardiac Surgery, University of Oulu, Oulu, Finland.
authors.forename: Tatu
authors.initials: T
authors.lastname: Juvonen
authors.affiliation: San Raffaele University Hospital, Milan, Italy.
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
authors.affiliation: Cardiac Surgery Hesperia Hospital, Modena, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Gabbieri
authors.affiliation: Division of Cardiac Surgery, Mestre, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Mangino
authors.affiliation: Division of Cardiac Surgery, University of Parma, Parma, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Agostinelli
authors.affiliation: S. Maria della Misericordia Hospital, Udine, Italy.
authors.forename: Ugolino
authors.initials: U
authors.lastname: Livi
authors.affiliation: Division of Cardiac Surgery, Cuneo, Italy.
authors.forename: Omar
authors.initials: O
authors.lastname: Di Gregorio
authors.affiliation: Division of Cardiac Surgery, AOU, Trieste, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Minati
authors.affiliation: Division of Cardiac Surgery, University of Torino, Turin, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Rinaldi
authors.affiliation: Division of Cardiac Surgery, University of Padua, Padova, Italy.
authors.forename: Gino
authors.initials: G
authors.lastname: Gerosa
authors.affiliation: Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Faggian
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery*; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors; D056346:Sternotomy; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D016896:Treatment Outcome
keywords: Aortic valve disease; Aortic valve replacement; Bioprosthesis malfunction; Redo; Transapical transcatheter aortic valve replacement