The Annals of thoracic surgery · 2021
Nonaortic Valve Cardiac Surgery After Transcatheter Aortic Valve Replacement.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Fukuhara Shinichi, Ailawadi Gorav, Deeb G Michael
Аннотация
BACKGROUND: Despite the rapid adoption of transcatheter aortic valve replacement (TAVR), the frequency and outcomes of nonaortic valve cardiac surgery after TAVR are unknown.
METHODS: Nonaortic valve surgery after TAVR from 2011 to 2019 was queried using the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database. A total of 666 patients, including 47 (7.1%) unplanned TAVR explants and 3 (0.5%) aborted procedures during nonaortic valve procedures, were identified.
RESULTS: These 666 procedures were performed by 459 surgeons (median, 1.0 case per surgeon) from 308 centers (median, 1.0 case per center), representing 29% of STS Database participants. The case number increased over time from 4 in 2011 to 204 in 2019, largely attributable to coronary artery bypass grafting (CABG) (n = 283; 42.5%) and mitral valve (n = 258; 38.7%) procedures. The median age patients of was 75.0 years, and 51.4% had undergone previous cardiac surgical procedures. The 30-day mortality of the entire cohort was 17.0%. Subgroups with particularly high mortality included patients with robot-assisted mitral surgery (n = 5/12; 41.7%), an unplanned TAVR explant (n = 19/47; 40.4%), open atrial transcatheter mitral valve replacement (n = 10/33; 30.3%), and aortic repair (n = 24/79; 29.8%). Among 390 patients with available STS predicted risk of mortality, the 30-day mortality in patients with isolated CABG, patients with isolated mitral repair or replacement, and in the entire group was 8.4% (n = 19/225), 13.5% (n = 21/155), and 10.8% (n = 42/390) with corresponding observed-to-expected mortality (O/E) ratios of 1.8, 1.8, and 1.7, respectively.
CONCLUSIONS: Nonaortic valve operation after TAVR was associated with a high mortality and O/E ratio. The TAVR team must be mindful of a "lifetime management" strategy, including assessment of concurrent diseases during TAVR candidate selection.
METHODS: Nonaortic valve surgery after TAVR from 2011 to 2019 was queried using the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database. A total of 666 patients, including 47 (7.1%) unplanned TAVR explants and 3 (0.5%) aborted procedures during nonaortic valve procedures, were identified.
RESULTS: These 666 procedures were performed by 459 surgeons (median, 1.0 case per surgeon) from 308 centers (median, 1.0 case per center), representing 29% of STS Database participants. The case number increased over time from 4 in 2011 to 204 in 2019, largely attributable to coronary artery bypass grafting (CABG) (n = 283; 42.5%) and mitral valve (n = 258; 38.7%) procedures. The median age patients of was 75.0 years, and 51.4% had undergone previous cardiac surgical procedures. The 30-day mortality of the entire cohort was 17.0%. Subgroups with particularly high mortality included patients with robot-assisted mitral surgery (n = 5/12; 41.7%), an unplanned TAVR explant (n = 19/47; 40.4%), open atrial transcatheter mitral valve replacement (n = 10/33; 30.3%), and aortic repair (n = 24/79; 29.8%). Among 390 patients with available STS predicted risk of mortality, the 30-day mortality in patients with isolated CABG, patients with isolated mitral repair or replacement, and in the entire group was 8.4% (n = 19/225), 13.5% (n = 21/155), and 10.8% (n = 42/390) with corresponding observed-to-expected mortality (O/E) ratios of 1.8, 1.8, and 1.7, respectively.
CONCLUSIONS: Nonaortic valve operation after TAVR was associated with a high mortality and O/E ratio. The TAVR team must be mindful of a "lifetime management" strategy, including assessment of concurrent diseases during TAVR candidate selection.