Transcatheter aortic valve replacement versus surgical aortic valve replacement in patients with previous coronary artery bypass surgery: A systematic review and meta-analysis.
BACKGROUND
Patients with severe aortic stenosis (AS) and previous coronary artery bypass graft (CABG) surgery have increased risk for aortic valve replacement. Whether surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) offers better outcomes in this population is unclear. We aimed to assess outcomes of TAVR and SAVR in patients with previous CABG.


METHODS
A systematic literature search of Medline, EMBASE and Cochrane library was conducted. Studies that reported clinical outcomes (perioperative or mid-term all-cause-mortality, cardiovascular mortality, pacemaker implantation, hospital duration and stroke) were included. Random-effect modeling was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs).


RESULTS
Five cohort studies including a total of 872 patients (423 in TAVR, 449 in SAVR) were analyzed. STS scores were comparable between the two groups. No difference in all-cause-mortality, cardiovascular mortality and stroke at 30days, 1year and total follow-up period was seen between the two groups. TAVR patients had higher pacemaker implantation rates (OR 3.41, 95% CI 1.66-6.38, p<0.001, I(2)=21%) and shorter hospital stay (-2.63days, 95% CI -5.20 to -0.04, p=0.05, I(2)=43%).


CONCLUSIONS
Patients with previous CABG who underwent TAVR had similar perioperative and long-term survival while experiencing more pacemaker implantations and shorter hospital stay compared to those who had SAVR making TAVR a safe and efficacious alternative to SAVR.
Wayne State University, Detroit Medical Center, Division of Cardiology, Detroit, MI 48226, USA.
Tomo
T
Ando
Wayne State University, Detroit Medical Center, Division of Cardiology, Detroit, MI 48226, USA. Electronic address: alexbriasoulis@gmail.com.
Alexandros
A
Briasoulis
Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA.
Anthony A
AA
Holmes
Wayne State University, Detroit Medical Center, Division of Cardiology, Detroit, MI 48226, USA.
Luis
L
Afonso
Wayne State University, Detroit Medical Center, Division of Cardiology, Detroit, MI 48226, USA.
Theodore
T
Schreiber
Wayne State University, Detroit Medical Center, Division of Cardiology, Detroit, MI 48226, USA.
Ashok
A
Kondur
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000379:methods; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D016032:Randomized Controlled Trials as Topic; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D016896:Treatment Outcome
Aortic stenosis; Coronary artery bypass graft; Surgical aortic valve replacement; Transcatheter aortic valve replacement