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- Title
052 CONVENTIONAL AORTIC VALVE REPLACEMENT OR TRANSCATHETER AORTIC VALVE IMPLANTATION IN PATIENTS WITH PREVIOUS CARDIAC SURGERY.
- Authors
Wendt, D.; Al-Rashid, F.; Kahlert, P.; El-Chilali, K.; Demircioglu, E.; Erbel, R.; Jakob, H.G.; Thielmann, M.
- Abstract
Objectives: Clinical outcomes were compared between patients with previous cardiac surgery undergoing transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (AVR).Methods: A total of 62 consecutive patients (group 1) with previous cardiac surgery were treated by TAVI either by the transfemoral (n = 45) or transapical access (n = 17) and were compared to patients (group 2, n = 51) with previous cardiac surgery treated by surgical reoperation. A multivariate logistic regression model was constructed to identify covariates among baseline values which were used for propensity score matching. Moreover, mortality was compared between both groups by Cox regression.Results: Both groups differed significantly (P < 0.01) in regard to age and preoperative risk scores (EuroSCORE and STS score). Thirty-day mortality was 14.5% (9/62) in group 1 and 5.8% (3/51) in group 2 (P = 0.23). Risk-adjusted multivariable analysis revealed only the logistic EuroSCORE to be strongly correlated with 30-day mortality (P = 0.01). Multivariate analysis showed no difference in 30-day mortality depending on group membership (P < 0.29). To further control for selection bias, a propensity score model was computed and also confirmed no difference in regard to 30-day mortality between both groups. Multivariate Cox regression revealed NYHA functional class (P = 0.006), logistic EuroSCORE (P = 0.009) and STS score (P = 0.03) to be strongly associated with overall mortality. Moreover, evaluating overall mortality, Cox regression showed no difference according to group membership (P < 0.72).Conclusion: The present study shows that in patients with cardiac reoperation, TAVI (despite higher risk scores) comes with similar outcomes when compared to surgical AVR. On the other hand, conventional redo AVR is still a valuable and safe treatment option.
- Publication
Interactive Cardiovascular & Thoracic Surgery, 2014, Vol 19, Issue suppl_1, pS16
- ISSN
1569-9293
- Publication type
Article
- DOI
10.1093/icvts/ivu276.52