Aortic valve replacement after previous heart surgery in high-risk patients: Transapical aortic valve implantation versus conventional aortic valve replacement鈥攁 risk-adjusted and propensity score-based analysis

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• 作者：Maximilian Scherner ; MD^a ; ^{maximilian.scherner@uk-koeln.de" class="auth_mail} ; Navid Madershahian ; MD^a ; Kathrin Kuhr ; MSc^b ; Stephan Rosenkranz ; MD^c ; Elisabeth Stö ; ger ; MD^a ; Parwis Rahmanian ; MD^a ; YeongHoon Choi ; MD^a ; Ingo Slottosch ; MD^a ; Jens Wippermann ; MD^a ; Justus Strauch ; MD^d ; Thorsten Wahlers ; MD^a
• 关键词：28.1 ; 35.2
• 刊名：The Journal of Thoracic and Cardiovascular Surgery
• 出版年：July 2014
• 年：2014
• 卷：148
• 期：1
• 页码：90-97
• 全文大小：658 K

文摘

Cardiac reoperations have been associated with increased morbidity and mortality compared with first-time surgery. We analyzed our experience with reoperative aortic valve replacement (redo-AVR) and compared these results with those from patients who had undergone transapical aortic valve implantation (TA-AVI) as a second heart operation.

Methods

In the present retrospective observational comparative study, we analyzed the outcome of 136 patients with previous cardiac surgery who had undergone conventional redo-AVR (n = 59; since 2006) or TA-AVI (n = 77; since 2008) with respect to the 30-day outcomes (Valve Academic Research Consortium criteria), 1- and 3-year survival, and the risk factors for both approaches after previous heart surgery.

Results

Neither group differed significantly in their risk profile, leading to similar Society of Thoracic Surgeon score and EuroSCORE. The 30-day mortality was 3.39% (n = 2) in the redo-AVR group and 7.8% (n = 6) in the redo TA-AVI group (P = .465). The overall combined safety endpoint at 30 days was significantly lower for the TA-AVI patients (18.1% vs 33.9% in redo-AVR; P = .036). The unadjusted and adjusted 1-year survival showed no difference between the 2 groups. The unadjusted 3-year survival revealed a 2.1-fold greater mortality risk after TA-AVI (P = .055). Adjustment by multivariate Cox regression analysis (hazard ratio, 1.427; 95% confidence interval, 0.635-3.209; P = .389) and propensity score (hazard ratio, 1.571; 95% confidence interval, 0.575-4.291; P = .378) led to a >50% risk reduction, resulting in similar 3-year survival in the 2 groups.

Conclusions

Redo-AVR can be performed with acceptable results in high-risk patients and still serves as the reference standard. Reoperative valve surgery by TA-AVI is feasible and results in comparable short- and mid-term survival.