Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Paris, France.
Eur J Cardiothorac Surg. 2012 Mar;41(3):499-504. doi: 10.1093/ejcts/ezr041. Epub 2011 Nov 11.
Surgical aortic valve replacement in patients with previous coronary artery bypass grafting (CABG) carries a high mortality. Transcatheter aortic valve implantation (TAVI) has been shown to be successful in high risk subgroups of patients. Our goal is therefore to evaluate the impact of a history of CABG on the outcome of patients who undergo TAVI.
From October 2006 to June 2010, among the 201 patients selected to undergo TAVI, 54 (27%) had a history of CABG. Outcomes were prospectively collected.
The 30-day outcome was not different between patients with previous CABG vs. those without, in particular as regards mortality (respectively, 5.6% vs. 10.9%; P = 0.25). Mid-term survival (mean FU: 7 ± 9 months) was not different at 2 years between patients with previous CABG vs. patients without (65.7 ± 6.2% vs. 80.0 ± 7.7% respectively; P = 0.12). In multivariate analysis, CABG was not associated with an excess mid-term mortality after TAVI.
Previous CABG does not adversely affect outcome in patients undergoing TAVI. If confirmed by larger prospective series and ideally by a randomized trial comparing CABG vs. redo surgery, this observation might lead the heart team to consider TAVI as an attractive option in the population of high risk patients with aortic stenosis and previous CABG.
在既往行冠状动脉旁路移植术（CABG）的患者中进行外科主动脉瓣置换术死亡率较高。经导管主动脉瓣植入术（TAVI）已被证明在高危亚组患者中是成功的。因此，我们的目标是评估 CABG 病史对行 TAVI 患者结局的影响。
在 2006 年 10 月至 2010 年 6 月期间，在 201 名入选行 TAVI 的患者中，有 54 名（27%）有 CABG 病史。前瞻性收集结局数据。
既往 CABG 与无 CABG 的患者在 30 天结局方面无差异，特别是死亡率（分别为 5.6%和 10.9%；P = 0.25）。在中位随访（平均 FU：7±9 个月）2 年内，既往 CABG 与无 CABG 的患者之间的中期生存率无差异（分别为 65.7±6.2%和 80.0±7.7%；P = 0.12）。多变量分析显示，TAVI 后 CABG 与中期死亡率增加无关。
既往 CABG 不会对行 TAVI 的患者的结局产生不利影响。如果这一观察结果得到更大的前瞻性系列研究和理想的比较 CABG 与再次手术的随机试验的证实，这一观察结果可能会使心脏团队考虑将 TAVI 作为主动脉瓣狭窄和既往 CABG 的高危患者的一个有吸引力的选择。
