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TAVR use increasing in patients with aortic stenosis, prior CABG
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Among patients with severe aortic stenosis and prior CABG, aortic valve replacement is being increasingly done with transcatheter instead of surgical procedures, researchers reported.
TAVR is associated with similar in-hospital mortality but lower rates of in-hospital complications compared with surgical AVR in this population, Tanush Gupta, MD, from the division of cardiology at Montefiore Medical Center, Albert Einstein College of Medicine, and colleagues wrote.
The researchers analyzed 15,055 patients with prior CABG who underwent isolated TAVR (mean age, 81 years; 26% women) or surgical AVR (mean age, 74 years; 19% women) from 2012 to 2014 and were included in the National Inpatient Sample databases.
In the cohort, TAVR procedures increased from 1,615 in 2012 to 4,400 in 2014, whereas surgical AVR procedures decreased from 2,285 in 2012 to 1,895 in 2014 (P for trend < .001), according to the researchers.
“Reoperative AVR in patients with prior CABG is technically challenging because of calcification of the aortic arch, scarring of the mediastinum and risk of damage to the bypass grafts,” Gupta and colleagues wrote. “With the advent of TAVR in the last decade, there has been a paradigm shift in the management of patients with prior CABG requiring AVR.”
For comparison of outcomes, the researchers matched 3,880 patients in each group based on baseline characteristics.
In the propensity-matched groups, in-hospital mortality was similar (TAVR, 2.4%; surgery, 2.3%; P = .71), Gupta and colleagues wrote.
However, they wrote, compared with the surgical AVR group, the TAVR group had lower rates of the following in-hospital complications: MI (1.5% vs. 3.4%; P < .001), stroke (1.4% vs. 2.7%; P < .001), bleeding complications (10.6% vs. 24.6%; P < .001) and acute kidney injury (16.2% vs. 19.3%; P < .001).
There was no difference between the groups in incidence of vascular complications or acute kidney injury requiring dialysis, but permanent pacemakers were required more often in the TAVR group, according to the researchers.
In addition, length of stay was shorter in the TAVR group (6.6 days vs. 9.1 days; adjusted parameter estimate = 0.73; 95% CI, 0.71-0.74).
“Lower rates of in-hospital complications with TAVR coupled with shorter [length of stay] and lower utilization of skilled nursing facilities support the use of TAVR over [surgical] AVR as the preferred modality of AVR in patients with prior CABG,” Gupta and colleagues wrote. – by Erik Swain
Disclosures: Gupta reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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