Key result
TF-TAVR linked to ~30% higher home discharge rate and shorter stays vs SAVR.
Why the study?
Although TAVR is a safe alternative to SAVR after prior CABG, differences in morbidity and discharge location between the two procedures remain less thoroughly characterized.
Does transfemoral transcatheter aortic valve replacement improve in-hospital morbidity, length of stay, and discharge location compared to surgical aortic valve replacement in patients with severe aortic stenosis and prior coronary artery bypass grafting?
Cohort (n=1,059)
No
Does transfemoral transcatheter aortic valve replacement improve in-hospital morbidity, length of stay, and discharge location compared to surgical aortic valve replacement in patients with severe aortic stenosis and prior coronary artery bypass grafting?
In patients with severe aortic stenosis and prior CABG, TF-TAVR is associated with lower in-hospital morbidity, shorter length of stay, and a higher likelihood of home discharge compared to SAVR.
TF-TAVR was associated with higher home discharge rates in prior CABG patients; extends prior trials but leaves open need for randomized confirmation.
BackgroundPublished trials have shown that transcatheter aortic valve replacement (TAVR) is a safe alternative to surgical aortic valve replacement (SAVR) after prior coronary artery bypass grafting (CABG). However, differences in morbidity and discharge location between the 2 procedures are less thoroughly characterized.MethodsFrom January 1, 2006 to January 7, 2020, 1059 patients with severe aortic stenosis after CABG underwent either SAVR (n = 315/30%), transfemoral TAVR (TF-TAVR) (n = 575/54%), or alternative access TAVR (n = 169/16%) at a single, tertiary care, academic institution. Propensity-weighted matching was used to compare morbidity, mortality, length of postprocedure stay, and nonhome discharge between TF-TAVR (effective n = 163) and SAVR (effective n = 163) groups.ResultsAmong propensity-weighted groups, the TF-TAVR group experienced fewer transfusions than the SAVR group (effective n = 16 [9.5%] vs. 132 [81%]; p < 0 .0001), less new-onset atrial fibrillation (effective n = 5.1 [3.1%] vs. 43 [27%]; p = 0.009), and less prolonged mechanical ventilation >24 hours (effective n = 0.41 [0.25%] vs. 30 [18%]; p <0.0001). Permanent pacemaker implant was 9.3% (effective n = 13) after TF-TAVR vs. 5.5% (effective n = 7.9; p = 0.2) after SAVR, stroke 0.41% (effective n = 0.67) vs. 2.1% (effective n = 3.5; p = 0.2), and operative mortality 0.5% (effective n = 0.8) vs. 1.7% (effective n = 2.8; p = 0.8). The TF-TAVR group had shorter postprocedure lengths of stay (2.0 vs. 7.6 days; p < 0.0001). Discharge home was more common after TF-TAVR than SAVR (effective n = 156 [95%] vs. 118 [73%]; p = 0.01).ConclusionsFor patients developing severe aortic stenosis after CABG, TF-TAVR rather than SAVR should be strongly considered because of lower morbidity, shorter length of stay, and greater likelihood of home discharge.
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Hasan et al. (2022) conducted a cohort in Severe aortic stenosis with prior coronary artery bypass grafting (n=1,059). Transfemoral transcatheter aortic valve replacement (TF-TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on Discharge home (p=0.01). Transfemoral transcatheter aortic valve replacement resulted in a significantly higher rate of home discharge (95% vs 73%, p=0.01) and shorter length of stay compared to surgical aortic valve replacement.
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