Reply to Özahn et al.: “Challenges in sutureless aortic valve implantation with minimal invasive technique”

Sef, Davorin; Krajnc, Martina; Klokočovnik, Tomislav

doi:10.1111/jocs.16757

Cited by 1 publication

(1 citation statement)

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“…This study has another limitation of being retrospective and nonrandomized, and it is subject to bias related to potential subsequent PCI procedures in both groups of patients. Lastly, we did not have a comparison group with octogenarians who underwent either minimally invasive approaches or TAVI with or without PCI [22,41,42]. However, this would require conducting further prospective and multicenter studies.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Survival among Octogenarians Undergoing Aortic Valve Replacement with or without Simultaneous Coronary Artery Bypass Grafting: A 22-Year Tertiary Single-Center Experience

Masraf

Sef

Chin

et al. 2023

JCM

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Background: The impact of concomitant coronary artery bypass grafting (CABG) on aortic valve replacement (AVR) in octogenarians is still debated. We analyzed the characteristics and long-term survival of octogenarians undergoing isolated AVR and AVR + CABG. Methods: All octogenarians who consecutively underwent AVR with or without concomitant CABG at our tertiary cardiac center between 2000 and 2022 were included. Patients with redo, emergent, or any other concomitant procedures were excluded. The primary endpoints were 30-day and long-term survival. The secondary endpoints were early postoperative outcomes and determinants of long-term survival. Univariable and multivariable logistic regression analyses were performed to identify independent predictors of 30-day mortality, and Cox regression analysis was performed for predictors of adverse long-term survival. Results: A total of 1011 patients who underwent AVR (83.0 [81.0–85.0] years, 42.0% males) and 1055 with AVR + CABG (83.0 [81.2–85.4] years, 66.1% males) were included in our study. Survival at 30 days and at 1, 3, and 5 years in the AVR group was 97.9%, 91.5%, 80.5%, and 66.2%, respectively, while in the AVR + CABG group it was 96.2%, 89.6%, 77.7%, and 64.7%, respectively. There was no significant difference in median postoperative survival between the AVR and AVR + CABG groups (7.1 years [IQR: 6.7–7.5] vs. 6.6 years [IQR: 6.3–7.2], respectively, p = 0.21). Significant predictors of adverse long-term survival in the AVR group included age (hazard ratio (HR): 1.09; 95% CI: 1.06–1.12, p < 0.001), previous MI (HR: 2.08; 95% CI: 1.32–3.28, p = 0.002), and chronic kidney disease (HR 2.07; 95% CI: 1.33–3.23, p = 0.001), while in the AVR + CABG group they included age (HR: 1.06; 95% CI: 1.04–1.10, p < 0.001) and diabetes mellitus (HR: 1.48; 95% CI: 1.15–1.89, p = 0.002). Concomitant CABG was not an independent risk factor for adverse long-term survival (HR: 0.89; 95% CI: 0.77–1.02, p = 0.09). Conclusions: The long-term survival of octogenarians who underwent AVR or AVR + CABG was similar and was not affected by adding concomitant CABG. However, octogenarians who underwent concomitant CABG with AVR had significantly higher in-hospital mortality. Each decision should be discussed within the heart team.

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Section: Discussionmentioning

confidence: 99%