title: Transapical transcatheter aortic valve replacement in patients with or without prior coronary artery bypass graft operation.
abstract: BACKGROUND
  Transapical approach (TA) is an established access alternative to the transfemoral technique in patients undergoing transcatheter aortic valve replacement (TAVR) for treatment of symptomatic aortic valve stenosis. The impact of prior coronary artery bypass grafting (CABG) on clinical outcomes in patients undergoing TA-TAVR is not well defined.
  
  
  METHODS
  A single center retrospective cohort analysis of 126 patients (male 41%, mean age 85.8 ± 6.1 years) who underwent TA balloon expandable TAVR (Edwards SAPIEN, SAPIEN XT or SAPIEN 3) was performed. Patients were classified as having prior CABG (n = 45) or no prior CABG (n = 81). Baseline clinical characteristics, in-hospital, 30-day, 6 months and one-year clinical outcomes were compared.
  
  
  RESULTS
  Compared to patients without prior CABG, CABG patients were more likely to be male (62.2 vs. 29.6%, p < 0.001) with a higher STS score (11.66 ± 5.47 vs. 8.99 ± 4.19, p = 0.003), history of myocardial infarction (55 vs. 21.1%, p < 0.001), implantable cardioverter defibrillator (17.8 vs. 3.7%, p = 0.017), left main coronary artery disease (42.2 vs. 4.9%, p < 0.001), and proximal left anterior descending coronary artery stenosis (57.8 vs. 16%, p < 0.001). They also presented with a lower left ventricular ejection fraction (%) (42.3 ± 15.3 vs. 54.3 ± 11.6, p < 0.01) and a larger effective valve orifice area (0.75 ± 0.20 cm2vs. 0.67 ± 0.14 cm2, p = 0.025). There were no intra-procedural deaths, no differences in stroke (0 vs. 1.2%, p = 1.0), procedure time in hours (3.50 ± 0.80 vs. 3.26 ± 0.86, p = 0.127), re-intubation rate (8.9 vs. 8.6% p = 1.0), and renal function (highest creatinine value 1.73 ± 0.71 mg/ml vs.1.88 ± 1.15 mg/ml, p = 0.43). All-cause mortality at 6 months was similar in both groups (11.4, vs. 17.3% p = 0.44), and one-year survival was 81.8 and 77.8% respectively (p = 0.51). On multivariate analysis, the only factor significantly associated with one-year mortality was prior history of stroke (HR, 2.76; 95% CI, 1.06-7.17, p = 0.037).
  
  
  CONCLUSIONS
  Despite the higher baseline clinical risk profile, patients with history of prior CABG undergoing TA-TAVR had comparable in-hospital, 6 months and one-year clinical outcomes to those without prior CABG.
authors.affiliation: William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.
authors.forename: Konstantinos V
authors.initials: KV
authors.lastname: Voudris
authors.affiliation: William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.|Department of Cardiology, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.
authors.forename: S Chiu
authors.initials: SC
authors.lastname: Wong
authors.affiliation: William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.|Department of Cardiology, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Kaple
authors.affiliation: William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.
authors.forename: Polydoros N
authors.initials: PN
authors.lastname: Kampaktsis
authors.affiliation: William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.|Department of Cardiothoracic Surgery, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.
authors.forename: Andreas R
authors.initials: AR
authors.lastname: de Biasi
authors.affiliation: William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.|Department of Cardiothoracic Surgery, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Weiss
authors.affiliation: William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.|Department of Cardiology, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Devereux
authors.affiliation: William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.|Department of Cardiothoracic Surgery, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.
authors.forename: Karl
authors.initials: K
authors.lastname: Krieger
authors.affiliation: William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.|Department of Cardiology, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.
authors.forename: Luke
authors.initials: L
authors.lastname: Kim
authors.affiliation: Department of Cardiology, Duke University Medical Center and the Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Rajesh V
authors.initials: RV
authors.lastname: Swaminathan
authors.affiliation: William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.|Department of Cardiology, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.
authors.forename: Dmitriy N
authors.initials: DN
authors.lastname: Feldman
authors.affiliation: William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.|Department of Cardiology, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.
authors.forename: Harsimran
authors.initials: H
authors.lastname: Singh
authors.affiliation: William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.|Department of Anesthesiology, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.
authors.forename: Nikolaos J
authors.initials: NJ
authors.lastname: Skubas
authors.affiliation: William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.|Department of Cardiology, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Minutello
authors.affiliation: William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.|Department of Cardiology, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Bergman
authors.affiliation: William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA. ars9001@med.cornell.edu.|Department of Cardiothoracic Surgery, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA. ars9001@med.cornell.edu.
authors.forename: Arash
authors.initials: A
authors.lastname: Salemi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D007668:Kidney / Q000502:physiology; D008297:Male; D061646:Operative Time; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D015996:Survival Rate; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome
keywords: Aortic valve stenosis; Coronary artery bypass grafting; Outcomes; Transcatheter aortic valve replacement