scholarly journals Transcatheter Versus Surgical Aortic Valve Replacement in Patients with Cardiac Surgery: Meta-Analysis and Systematic Review of the Literature

2020 ◽  
Vol 7 (3) ◽  
pp. 36
Author(s):  
Azka Latif ◽  
Noman Lateef ◽  
Muhammad Junaid Ahsan ◽  
Vikas Kapoor ◽  
Rana Mohammad Usman ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Hospital Stay ◽  
Valve Replacement ◽  
Lower Incidence ◽  
Surgical Aortic Valve Replacement ◽  
Clinical Endpoints ◽  
Duration Of Hospital Stay ◽  
All Cause Mortality

The number of patients with severe aortic stenosis (AS) and a history of prior cardiac surgery has increased. Prior cardiac surgery increases the risk of adverse outcomes in patients undergoing aortic valve replacement. To evaluate the impact of prior cardiac surgery on clinical endpoints in patients undergoing transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR), we performed a literature search using PubMed, Embase, Google Scholar, and Scopus databases. The clinical endpoints included in our study were 30-day mortality, 1–2-year mortality, acute kidney injury (AKI), bleeding, stroke, procedural time, and duration of hospital stay. Seven studies, which included a total of 8221 patients, were selected. Our study found that TAVR was associated with a lower incidence of stroke and bleeding complications. There was no significant difference in terms of AKI, 30-day all-cause mortality, and 1–2-year all-cause mortality between the two groups. The average procedure time and duration of hospital stay were 170 min less (p ≤ 0.01) and 3.6 days shorter (p < 0.01) in patients with TAVR, respectively. In patients with prior coronary artery bypass graft and severe AS, both TAVR and SAVR are reasonable options. However, TAVR may be associated with a lower incidence of complications like stroke and perioperative bleeding, in addition to a shorter length of stay.

scholarly journals Preoperative Atrial Fibrillation is associated with long-term morTality in patients undergoing suRgical AortiC valvE Replacement

2021 ◽  
Author(s):  
Mohamed Farag ◽  
Yusuf Kiberu ◽  
Ashwin Reddy ◽  
Ahmad Shoaib ◽  
Mohaned Egred ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Surgical Aortic Valve Replacement ◽  
Term Survival ◽  
The Impact ◽  
Long Term Mortality

Introduction Atrial fibrillation (AF) is frequent after any cardiac surgery, but evidence suggests it may have no significant impact on survival if sinus rhythm (SR) is effectively restored early after the onset of the arrhythmia. In contrast, management of preoperative AF is often overlooked during or after cardiac surgery despite several proposed protocols. This study sought to evaluate the impact of preoperative AF on mortality in patients undergoing isolated surgical aortic valve replacement (AVR). Methods We performed a retrospective, single-centre study involving 2,628 consecutive patients undergoing elective, primary isolated surgical AVR from 2008 to 2018. A total of 268/ 2,628 patients (10.1%) exhibited AF before surgery. The effect of preoperative AF on mortality was evaluated with univariate and multivariate analyses. Results Short-term mortality was 0.8% and was not different between preoperative AF and SR cohorts. Preoperative AF was highly predictive of long-term mortality (median follow-up of 4 years [Q1-Q3 2-7]; HR: 2.24, 95% CI: 1.79-2.79, P<0.001), and remained strongly and independently predictive after adjustment for other risk factors (HR: 1.54, 95% CI: 1.21-1.96, P<0.001) compared with preoperative SR. In propensity score-matched analysis, the adjusted mortality risk was higher in the AF cohort (OR: 1.47, 95% CI: 1.04-1.99, P=0.03) compared with the SR cohort. Conclusions Preoperative AF was independently predictive of long-term mortality in patients undergoing isolated surgical AVR. It remains to be seen whether concomitant surgery or other preoperative measures to correct AF may impact long-term survival.

scholarly journals Transcatheter versus Surgical Aortic Valve Replacement after Previous Cardiac Surgery: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 2018 ◽  
pp. 1-11 ◽  
Author(s):  
Sharaf-Eldin Shehada ◽  
Yacine Elhmidi ◽  
Öznur Öztürk ◽  
Markus Kasel ◽  
Antonio H. Frangieh ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Pacemaker Implantation ◽  
Major Adverse Cardiovascular Events ◽  
Cochrane Central Register ◽  
Surgical Aortic Valve Replacement ◽  
Promising Alternative ◽  
Valve Diseases

Aim. Aortic valve replacement (AVR) in patients with prior cardiac surgery might be challenging. Transcatheter aortic valve replacement (TAVR) offers a promising alternative in such patients. We therefore aimed at comparing the outcomes of patients with aortic valve diseases undergoing TAVR versus those undergoing surgical AVR (SAVR) after previous cardiac surgery. Methods and Results. MEDLINE, EMBASE, and the Cochrane Central Register were searched. Seven relevant studies were identified, published between 01/2011 and 12/2015, enrolling a total of 1148 patients with prior cardiac surgery (97.6% prior CABG): 49.2% underwent TAVR, whereas 50.8% underwent SAVR. Incidence of stroke (3.8 versus 7.9%, p=0.04) and major bleeding (8.3 versus 15.3%, p=0.04) was significantly lower in the TAVR group. Incidence of mild/severe paravalvular leakage (14.4/10.9 versus 0%, p<0.0001) and pacemaker implantation (11.3 versus 3.9%, p=0.01) was significantly higher in the TAVR group. There were no significant differences in the incidence of acute kidney injury (9.7 versus 8.7%, p=0.99), major adverse cardiovascular events (8.7 versus 12.3%, p=0.21), 30-day mortality (5.1 versus 5.5%, p=0.7), or 1-year mortality (11.6 versus 11.8%, p=0.97) between the TAVR and SAVR group. Conclusions. TAVR as a redo procedure offers a safe alternative for patients presenting with aortic valve diseases after previous cardiac surgery especially those with prior CABG.

scholarly journals P301 The prognostic value of preoperative left atrial volume after surgical aortic valve replacement in patients with isolated severe aortic stenosis and preserved left ventricular ejection fraction

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A D Mateescu ◽  
A Calin ◽  
M Rosca ◽  
C C Beladan ◽  
R Enache ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Ejection Fraction ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Left Atrial ◽  
Prognostic Value ◽  
Left Ventricular ◽  
Volume Index ◽  
Surgical Aortic Valve Replacement ◽  
All Cause Mortality

Abstract Background Left atrial (LA) volume is an important cardiovascular prognostic marker. However, data regarding the prognostic value of LA volume in severe AS patients (pts) after surgical aortic valve replacement (AVR) are scarce. Moreover, the predictive role of LA function in AS pts after AVR has not yet been studied. Our study aimed to assess the relationship of LA volume index (LAVi) and function with outcome, in terms of mortality, in severe AS pts who underwent surgical AVR. Methods A total of 360 consecutive pts with isolated severe AS (aortic valve area index ≤ 0.6 cm2/m2) referred to our echocardiography laboratory were prospectively screened. Two hundred and seventeen pts with preserved left ventricular (LV) ejection fraction (≥50%) and in sinus rhythm were enrolled. All patients underwent a baseline comprehensive echocardiogram, including speckle tracking analysis of both LV and LA strain. Symptomatic pts (142 pts, 65%) that were subject to AVR were followed for a median period of 4 years (IQR 3-6 years). The endpoint was all-cause mortality after AVR. The last update of the survival status was obtained in January 2019. Outcome data were available in 116 severe AS pts that underwent AVR (mean age 63 ± 10 yrs, 56% men), who formed the final study population. Results Seventeen (14%) pts died during follow-up. No significant differences were found between nonsurvivors and survivors after AVR in terms of age and cardiovascular risk factors. Nonsurvivors had higher BNP plasma values (p=.04) at baseline compared with surviving pts. Survivors and nonsurvivors alike exhibited similar preoperative AS severity and LV systolic function parameters (ejection fraction and global longitudinal strain). Moreover, there were no significant differences between the two groups regarding baseline valvuloarterial impedance, average E/e’ ratio, and LA longitudinal deformation parameters. Nonsurvivors had a tendency toward higher LV mass index (p=.08). Nonsurvivors had higher preoperative LA volume index (LAVi)(50 ± 12 vs. 44 ± 10 ml/m2, p=.003). In a multivariable Cox regression analysis adjusted for age, LAVi emerged as the only independent predictor for death in our population study (HR 1.06, 95% CI 1.01-1.11, p=.02). A cut-off value for LAVi derived from ROC curve analysis was used to construct Kaplan-Meier survival curves. A value of 43 ml/m2 for LAVi predicted all-cause mortality after AVR in severe AS pts with 71% sensitivity and 54% specificity. Conclusions In our study, preoperative LAVi predicted death in severe AS pts after surgical AVR. LAVi assessment may improve preoperative risk stratification in patients with severe AS, however further larger prospective studies are needed. Abstract P301 Figure.

scholarly journals Transcatheter and Surgical Aortic Valve Replacement in Patients With Previous Cardiac Surgery: A Meta-Analysis

2021 ◽  
Vol 7 ◽  
Author(s):  
Yi-ming Li ◽  
Jia-yu Tsauo ◽  
Kai-yu Jia ◽  
Yan-biao Liao ◽  
Fan Xia ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Meta Analysis ◽  
Surgical Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Risk Patients

Background: Many patients who have aortic stenosis and are transcatheter aortic valve replacement (TAVR) candidates have underwent prior cardiac surgery (PCS). The aim of this study was to provide a robust summary comparison between patients with PCS who underwent TAVR vs. surgical aortic valve replacement (SAVR).Methods: We conducted a systematic review and meta-analysis of all published articles on PubMed/Medline, Ovid, EMBASE, and Scopus from 2002 to 2019.Results: A total of 13 studies were finally included, yielding a total of 23,148 participants. There was no statistical difference with 30-day [OR: 1.02 (0.86–1.21)] or 1-year mortality [OR: 1.18 (0.86–1.61)] between the two groups. Subgroup analysis revealed that high-risk patients who underwent TAVR with the transapical approach were associated with increased risk of mortality [OR: 1.45 (1.00–2.11)]. However, those who underwent TAVR with endovascular approach had a comparable outcome with SAVR.Conclusions: Primary outcomes after endovascular TAVR were similar to those with SAVR and superior to transapical TAVR treatment group in patients with PCS.

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