Impact of previous cardiac surgery on patients undergoing transcatheter aortic valve implantation: A meta-analysis

Bajaj, Archna; Sethi, Arjinder; Rathor, Parul; Sehgal, Vasudha; Pancholy, Samir

doi:10.1016/j.hrtlng.2016.04.002

Cited by 6 publications

(10 citation statements)

References 32 publications

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“…In addition, results of subgroup analysis including only patients with a history of CABG also did not show differences between those groups [16]. Interestingly, the rate of major vascular complications was marginally lower in patients with previous cardiac surgery, but the calculation was not robust because the result lost significance in sensitivity analysis [16]. Also, the risk of acute MI was significantly higher in patients with prior sternotomy, but a higher prevalence of coronary artery disease (CAD) and diabetes mellitus in the previous cardiac surgery group was the probable reason for this worse outcome [16].…”

Section: Discussionmentioning

confidence: 84%

“…These data stay in line with results from most recent studies reporting no influence of prior cardiac surgery on survival rate after TAVI. A recent large meta-analysis has reported no significant difference in 30-day and one-year all-cause mortality between patients undergoing TAVI with and without a history of previous cardiac surgery with sternotomy (risk ratio 0.95, 95% CI 0.82-1.09, p = 0.55; risk ratio 0.94, 95% CI 0.86-1.02, p = 0.48, respectively) [16]. In addition, results of subgroup analysis including only patients with a history of CABG also did not show differences between those groups [16].…”

Section: Discussionmentioning

confidence: 96%

“…A recent large meta-analysis has reported no significant difference in 30-day and one-year all-cause mortality between patients undergoing TAVI with and without a history of previous cardiac surgery with sternotomy (risk ratio 0.95, 95% CI 0.82-1.09, p = 0.55; risk ratio 0.94, 95% CI 0.86-1.02, p = 0.48, respectively) [16]. In addition, results of subgroup analysis including only patients with a history of CABG also did not show differences between those groups [16]. Interestingly, the rate of major vascular complications was marginally lower in patients with previous cardiac surgery, but the calculation was not robust because the result lost significance in sensitivity analysis [16].…”

Section: Discussionmentioning

confidence: 96%

“…Interestingly, the rate of major vascular complications was marginally lower in patients with previous cardiac surgery, but the calculation was not robust because the result lost significance in sensitivity analysis [16]. Also, the risk of acute MI was significantly higher in patients with prior sternotomy, but a higher prevalence of coronary artery disease (CAD) and diabetes mellitus in the previous cardiac surgery group was the probable reason for this worse outcome [16]. However, most of the included studies were non-randomised or were post hoc analyses of randomised trials; thus, it may have limited the external validity of the analysis.…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Impact of previous cardiac surgery with sternotomy on clinical outcomes and quality of life after transcatheter aortic valve implantation for severe aortic stenosis

Tokarek¹,

Dziewierz²,

Bagieński³

et al. 2018

Kardiol Pol

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Impact of previous cardiac surgery with sternotomy on clinical outcomes and quality of life after transcatheter aortic valve implantation for severe aortic stenosis

Tokarek¹,

Dziewierz²,

Bagieński³

et al. 2018

Kardiol Pol

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“…Probably, left subclavian approach was not used due to the risk of compromising the left internal mammary artery, whereas the right approach is empirically avoided due to the risk of compromising the right carotid artery. Thorough research is still needed to clarify these aspects of the axillary approach in this scenario as it might represent a better alternative to transapical and transaortic ones.It is well-known that reoperation is one of the factors that most increases the risk in cardiac interventions, only exceeded by advanced age and the need for an emergency procedure [10][11][12]. The growing experience in valve-in-valve procedures both in aortic and mitral positions for degenerated bioprosthesis [13,14] and the positive results -in prognosis and quality of life -in patients with previous coronary bypass grafts [6] allow room for optimism regarding the impact of transcatheter technologies in the outcomes of our patients with the presence of prior cardiac surgery as their main comorbidity.…”

mentioning

confidence: 99%

Transcatheter aortic valve implantation: the optimal alternative to cardiac reoperation also from the patient’s perspective

Amat‐Santos¹,

Catalá²

2018

Kardiol Pol

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Article Tokarek et al., see p. 838The spread of transcatheter aortic valve implantation (TAVI) technologies to alternative scenarios in the near future is unquestionable, but several shortcomings still exist. The so-called "TAVI fever" has often led to the use of this promising technology in clinical conditions with unproven efficacy attending to current scientific evidence. Very old [1], multi-valvular [2][3][4], or oncological patients [5] represent some of the challenging scenarios where the use of TAVI might be attractive but remains empirical. Tokarek et al.[6] explored one important scenario still under-investigated despite the fact that one in four TAVI recipients present this condition: the presence of prior sternotomy for cardiac surgery.It is well-known that sternotomy is relatively safe by itself but not harmless [7]. Interestingly, the authors performed not only an assessment of prognostic outcomes, but they also gave a hint of the patient's perception of the procedure through prospective evaluation with quality-of-life scales. This has particular value in comparing conventional cardiac surgery and transcatheter technologies in a population that have experienced both kinds of procedures. Despite the relatively small sample, significant differences were found in global mortality, favouring TAVI in the long term. Also, better results in all evaluated items regarding quality of life (mobility, self-care, pain, etc.) were present, although statistical significance was not reached. The fact that ~20% of the patients were treated through transapical/transaortic approach should be taken into consideration to explain this. In the current series, this proportion is usually below 10% and, even though the authors suggest that both transapical and transfemoral approaches are reasonable in patients with previous cardiac operations, we should keep in mind that the transapical approach also requires a thoracotomy, which has been previously associated with a higher degree of discomfort for the patient, more periprocedural complications, and higher mortality [8]. As highlighted by the authors (and this is the main message from this work, from my perspective), we need to start wondering which alternatives are preferred by well-informed patients; and this information should include the consequences in all aspects related to the quality of life post-intervention. In this regard, alternative approaches to transapical/transaortic access in poor candidates to transfemoral access should be evaluated; transaxillary approach is a very good option with fewer induced comorbidities for the patient [9], but the investigation from Tokarek et al. [6] makes us wonder if we have enough information regarding the perception of the patient with this approach as compared to others. Additionally, more than 80% of the patients with prior sternotomy had undergone coronary artery bypass grafting. Probably, left subclavian approach was not used due to the risk of compromising the left internal mammary artery, whereas the right approach is empi...

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Transcatheter aortic valve with a novel self‐expandable device in patients with previous mechanical mitral valve prosthesis

Márquez

Moreno

Galeote

et al. 2022

Cathet Cardio Intervent

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Objectives: The aim of this study was to describe the procedural and early outcomes of patients with mechanical mitral valve prosthesis (MVP) undergoing transcatheter aortic valve replacement (TAVR) with a novel self-expandable retrievable device.Background: TAVR in patients with prior MVP may have an increased risk of complications related to device positioning and interference between both prosthetic valves.Methods: An observational study was conducted, including eight patients with severe symptomatic aortic stenosis and prior mechanical MVP who underwent TAVR with the novel device Allegra TM (Biosensors). No transesophageal monitoring was used. Results:The mean age of the study population was 75 years. The mean distance between MVP and aortic annulus was 3.8 mm. Procedural success was achieved in all patients with no major intraprocedural, in-hospital, or follow-up complications.Conclusions: TAVR with Allegra TAVI system in patients with prior MVP offers good procedural and clinical outcomes.

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Impact of previous cardiac surgery on patients undergoing transcatheter aortic valve implantation: A meta-analysis

Cited by 6 publications

References 32 publications

Impact of previous cardiac surgery with sternotomy on clinical outcomes and quality of life after transcatheter aortic valve implantation for severe aortic stenosis

Impact of previous cardiac surgery with sternotomy on clinical outcomes and quality of life after transcatheter aortic valve implantation for severe aortic stenosis

Transcatheter aortic valve implantation: the optimal alternative to cardiac reoperation also from the patient’s perspective

Transcatheter aortic valve with a novel self‐expandable device in patients with previous mechanical mitral valve prosthesis

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