Transcatheter versus surgical aortic valve replacement in patients with prior coronary artery bypass graft operation: a PARTNER trial subgroup analysis.

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Citation: Annals of Thoracic Surgery. 98(1):1-7; discussion 7-8, 2014 Jul.PMID: 24881859Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal Article | Randomized Controlled TrialSubject headings: *Aortic Valve Stenosis/su [Surgery] | *Cardiac Catheterization/mt [Methods] | *Coronary Artery Bypass | *Coronary Artery Disease/su [Surgery] | *Heart Valve Prosthesis Implantation/mt [Methods] | Aged, 80 and over | Aortic Valve Stenosis/co [Complications] | Aortic Valve Stenosis/mo [Mortality] | Coronary Artery Disease/co [Complications] | Coronary Artery Disease/di [Diagnosis] | Female | Follow-Up Studies | Humans | Male | Prospective Studies | Survival Rate/td [Trends] | Time Factors | Treatment Outcome | United States/ep [Epidemiology]Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007ISSN:
  • 0003-4975
Name of journal: The Annals of thoracic surgeryAbstract: BACKGROUND: The Placement of Aortic Transcatheter Valves (PARTNER) trial reported a reduced rate of mortality in patients with previous coronary bypass grafting (CABG) operation who received surgical aortic valve replacement (SAVR) in comparison with transcatheter aortic valve replacement (TAVR). We sought to further evaluate these groups.CONCLUSIONS: The 2-year follow-up of patients with a history of previous CABG operation in the PARTNER trial demonstrated improved outcomes with SAVR in comparison with TAVR. Further longitudinal assessment is necessary to corroborate these findings and to understand the possible causes. Copyright 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.METHODS: We reviewed the database of the 699 patients enrolled in the PARTNER trial. The cohort for this study consisted of 288 patients (41.2%) who had a history of CABG operation before enrollment in the PARTNER trial. All patients were followed up for 2 years.RESULTS: The mean age was 81.5+6.6 years, and 231 patients (80.2%) were men. The preoperative characteristics were similar in 140 patients (48.6%) who received SAVR and 148 (51.4%) who received TAVR. There were no differences between the two groups with respect to the operative outcomes of death, stroke, and myocardial infarction, but the TAVR patients experienced more paravalvular regurgitation (p<0.0001). At 2 years, there was a trend toward greater all-cause mortality in the TAVR patients (hazard ratio [HR] 1.53; 95% confidence interval [CI]: 0.99, 2.35; p=0.052). Furthermore, the TAVR patients had more repeated hospitalization (HR 1.75; 95% CI: 0.99, 3.07; p=0.05), death of any cause or repeated hospitalization (HR 1.52; 95% CI: 1.06, 2.19; p=0.02), and death of any cause or stroke (HR 1.51; 95% CI: 1.00, 2.27; p=0.05).All authors: Greason KL, Holmes DR, Leon MB, Mack M, Mathew V, McAndrew T, Pichard A, Rihal CS, Smith CR, Suri RM, Svensson L, Thourani V, Webb JG, Williams M, Xu KDigital Object Identifier: Date added to catalog: 2014-10-02
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article Available 24881859

Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007

BACKGROUND: The Placement of Aortic Transcatheter Valves (PARTNER) trial reported a reduced rate of mortality in patients with previous coronary bypass grafting (CABG) operation who received surgical aortic valve replacement (SAVR) in comparison with transcatheter aortic valve replacement (TAVR). We sought to further evaluate these groups.

CONCLUSIONS: The 2-year follow-up of patients with a history of previous CABG operation in the PARTNER trial demonstrated improved outcomes with SAVR in comparison with TAVR. Further longitudinal assessment is necessary to corroborate these findings and to understand the possible causes. Copyright 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

METHODS: We reviewed the database of the 699 patients enrolled in the PARTNER trial. The cohort for this study consisted of 288 patients (41.2%) who had a history of CABG operation before enrollment in the PARTNER trial. All patients were followed up for 2 years.

RESULTS: The mean age was 81.5+6.6 years, and 231 patients (80.2%) were men. The preoperative characteristics were similar in 140 patients (48.6%) who received SAVR and 148 (51.4%) who received TAVR. There were no differences between the two groups with respect to the operative outcomes of death, stroke, and myocardial infarction, but the TAVR patients experienced more paravalvular regurgitation (p<0.0001). At 2 years, there was a trend toward greater all-cause mortality in the TAVR patients (hazard ratio [HR] 1.53; 95% confidence interval [CI]: 0.99, 2.35; p=0.052). Furthermore, the TAVR patients had more repeated hospitalization (HR 1.75; 95% CI: 0.99, 3.07; p=0.05), death of any cause or repeated hospitalization (HR 1.52; 95% CI: 1.06, 2.19; p=0.02), and death of any cause or stroke (HR 1.51; 95% CI: 1.00, 2.27; p=0.05).

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