Left Ventricular Function Recovery after Transapical Transcatheter Aortic Valve Replacement in Patients with Previous Coronary Artery Bypass Graft Surgery
Alexis K. Okoh, Molly Schultheis, Margarita T. Camacho, Sari Kaplon, Mark Russo, RWJ Barnabas Health, Newark, New Jersey, USA
OBJECTIVE: To describe outcomes after trans apical trans catheter aortic valve replacement (TA-TAVR) in patients with previous coronary artery bypass graft (CABG) surgery and assess left ventricular (LV) function recovery post-TAVR in CABG/TA-TAVR patients with LV dysfunction.
METHODS: Patients who had TAVR via a TA approach at a single center were divided into two groups based on their previous history of CABG surgery. Post-operative outcomes were compared between groups and Cox proportional hazard regression analysis was used to identify predictors of all-cause mortality. CABG/TA-TAVR patients were sub-divided into two per baseline LVEF <50%. The changes in LVEF and valve-function at follow-up (1-12 months) were analyzed using paired t-tests.
RESULTS: Of 133 TA-TAVR patients, 39 (29%) had a surgical history of CABG. Overall all-cause mortality rates at 30-days, 1- year and 2-years were similar for both groups (p=0.59, p=0.64, p= 0.78). Higher STS scores (p=0.013) and a previous history of atrial fibrillation (p=0.0001) were independent predictors of overall all-cause mortality. Sub-grouping of CABG-TAVR patients (n=39) identified 22 patients (56%) with LVEF ‰¥ 50% vs. 17 (44%) with LVEF <50%. At 1-year follow up, significant improvements in LVEF (low LVEF group) and valve function for both groups were observed. LVEF ‰¥ 50% group (LVEF; ˆ†:-3 % p=0.878, AVA; ˆ†: 1.3cm2 p=<0.0001, mean gradient; ˆ†:-38mmHg, p<0.0001); LVEF < 50% group (LVEF; ˆ†: 10% p=0.01, AVA; ˆ†:1.3cm2, p=0.0004, MG; ˆ† -31mmHg, p<0.0001).
CONCLUSIONS: TA-TAVR has acceptable outcomes in CABG patients. Significant improvements in LV and valve functions are seen in mid-term follow-up.