[Impact of transcatheter aortic valve implantation in the treatment of aortic valve disease after previous coronary artery bypass]

Abstract

Introduction: Patients with a history of coronary artery bypass and aortic valve disease constitute a high-risk group for conventional redo surgery. The transcatheter aortic valve implantation (TAVI) may be an alternative for high-risk patients. The purpose of this study is to evaluate the impact of TAVI in the treatment of aortic valve disease after previous surgical coronary artery revascularization.

Patients and methods: This is a single-center retrospective, observational study, including 87 patients undergoing surgery for surgical heart valve replacement or TAVI from January 2007 to December 2013.

Results: The introduction of transcatheter aortic valve implantation techniques has doubled the number of redo patients treated for aortic valve disease. From 2010 to 2013, the patients treated by conventional surgery diminished by 30%, with improved postoperative outcomes. This study allowed us to notice differences in patient's in terms of operative risk factors. For the same reasons no comparison was possible between 2 subgroup of patients. Hospital mortality was 6.4% for conventional aortic surgery and 20% for transcatheter aortic valve treatment.

Conclusion: Surgery remains the standard treatment for aortic valve disease even in redo patients, but TAVI becomes a very interesting tool as it may represent a tailored approach for our patients.

Keywords: Aortic valve replacement; Chirurgie redux; Coronary artery bypass; Implantation de valve aortique par voie trans-cathéter (TAVI); Mortality; Mortalité ré-opérations; Pontages aorto-coronariens; Redo surgery; Remplacement valve aortique; Transcatheter aortic valve implantation.