open access

Vol 76, No 5 (2018)
Original articles
Published online: 2018-01-12
Submitted: 2017-07-27
Accepted: 2017-12-04
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Impact of previous cardiac surgery with sternotomy on clinical outcomes and quality of life after transcatheter aortic valve implantation for severe aortic stenosis

Tomasz Tokarek, Artur Dziewierz, Maciej Bagienski, Lukasz Rzeszutko, Danuta Sorysz, Pawel Kleczynski, Dariusz Dudek
DOI: 10.5603/KP.a2018.0028
·
Kardiol Pol 2018;76(5):838-844.

open access

Vol 76, No 5 (2018)
Original articles
Published online: 2018-01-12
Submitted: 2017-07-27
Accepted: 2017-12-04

Abstract

Background:

Transcatheter aortic valve implantation (TAVI) has evolved as an effective treatment in patients with symptomatic severe aortic stenosis (AS) and increased operative risk. Data on the influence of previous sternotomy on the risk of TAVI are limited.


Aim: We sought to investigate the effect of previous cardiac surgery with sternotomy on clinical outcomes and quality of life (QoL) after TAVI.


Methods: The study included 148 consecutive patients with symptomatic severe AS, who underwent TAVI. Baseline charac-teristics, procedural and long-term clinical outcomes, and QoL assessment with the EQ-5D-3L questionnaire were compared between patients with and without previous sternotomy.


Results: Patients with previous sternotomy (23.0% of the population) were younger and more often male, had higher rate of previous myocardial infarction (MI; 26 [22.8%] vs. 22 [64.7%], p = 0.001), and lower median left ventricular ejection frac-tion (60.0% [50.0–65.0] vs. 50.0% [42.0–60.0], p = 0.004). Periprocedural risk measured with the Logistic Euroscore and the Society of Thoracic Surgeons scale was comparable in both groups. There were no differences in 30-day and 12-month all-cause mortality between the groups with and without sternotomy (10 [8.8%] vs. 2 [5.9%], p = 0.7; odds ratio [OR] adjusted for age/sex/previous MI, 0.56, 95% confidence interval [CI] 0.10–3.29; for 12-month mortality adjusted OR 0.19, 95% CI 0.04–0.99). At the longest available follow-up, mortality was higher in patients without sternotomy (30 [26.3%] vs. 3 [8.8%], p = 0.03; adjusted OR 0.10, 95% CI 0.02–0.42). Similar rates of other complications after TAVI were noted. No differences in the EQ-5D-3L questionnaire at baseline and 12-month follow-up were confirmed.

Conclusions: TAVI seems to be a safe and effective technique for the treatment of severe AS in patients with previous cardiac surgery.

Abstract

Background:

Transcatheter aortic valve implantation (TAVI) has evolved as an effective treatment in patients with symptomatic severe aortic stenosis (AS) and increased operative risk. Data on the influence of previous sternotomy on the risk of TAVI are limited.


Aim: We sought to investigate the effect of previous cardiac surgery with sternotomy on clinical outcomes and quality of life (QoL) after TAVI.


Methods: The study included 148 consecutive patients with symptomatic severe AS, who underwent TAVI. Baseline charac-teristics, procedural and long-term clinical outcomes, and QoL assessment with the EQ-5D-3L questionnaire were compared between patients with and without previous sternotomy.


Results: Patients with previous sternotomy (23.0% of the population) were younger and more often male, had higher rate of previous myocardial infarction (MI; 26 [22.8%] vs. 22 [64.7%], p = 0.001), and lower median left ventricular ejection frac-tion (60.0% [50.0–65.0] vs. 50.0% [42.0–60.0], p = 0.004). Periprocedural risk measured with the Logistic Euroscore and the Society of Thoracic Surgeons scale was comparable in both groups. There were no differences in 30-day and 12-month all-cause mortality between the groups with and without sternotomy (10 [8.8%] vs. 2 [5.9%], p = 0.7; odds ratio [OR] adjusted for age/sex/previous MI, 0.56, 95% confidence interval [CI] 0.10–3.29; for 12-month mortality adjusted OR 0.19, 95% CI 0.04–0.99). At the longest available follow-up, mortality was higher in patients without sternotomy (30 [26.3%] vs. 3 [8.8%], p = 0.03; adjusted OR 0.10, 95% CI 0.02–0.42). Similar rates of other complications after TAVI were noted. No differences in the EQ-5D-3L questionnaire at baseline and 12-month follow-up were confirmed.

Conclusions: TAVI seems to be a safe and effective technique for the treatment of severe AS in patients with previous cardiac surgery.

Get Citation

Keywords

transcatheter aortic valve replacement, aortic valve disease, high-risk patients, registry

About this article
Title

Impact of previous cardiac surgery with sternotomy on clinical outcomes and quality of life after transcatheter aortic valve implantation for severe aortic stenosis

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 76, No 5 (2018)

Pages

838-844

Published online

2018-01-12

DOI

10.5603/KP.a2018.0028

Bibliographic record

Kardiol Pol 2018;76(5):838-844.

Keywords

transcatheter aortic valve replacement
aortic valve disease
high-risk patients
registry

Authors

Tomasz Tokarek
Artur Dziewierz
Maciej Bagienski
Lukasz Rzeszutko
Danuta Sorysz
Pawel Kleczynski
Dariusz Dudek

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