Previous coronary artery bypass graft is not associated with higher mortality in transcatheter aortic valve replacement: systemic review and meta-analysis

Abstract

Introduction: Patients with previous coronary artery bypass graft (CABG) are usually considered as high-risk groups perioperatively. Recent studies suggest that previous CABG is not associated with mortality in patients with severe aortic stenosis (AS) who underwent transcatheter aortic valve replacement (TAVR). However, systematic review and meta-analysis of the literature has not been done. Thus, we conducted this systematic review and meta-analysis to assess the association between previous CABG and mortality in patients undergoing TAVR.Methods: We comprehensively searched the databases of MEDLINE and EMBASE from inception to July 2018. Included studies were published prospective or retrospective cohort studies that evaluated the effects of previous CABG status on mortality risk among patients undergoing TAVR. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate risk ratios and 95% confidence intervals.Results: Eleven cohort studies from March 2010 to April 2018 were included in this meta-analysis involving 7299 subjects with severe AS undergoing TAVR (1890 with and 5409 without previous CABG). Previous CABG was not associated with all-cause mortality (pooled risk ratio = 0.96, 95% confidence interval: 0.80-1.16, p=.66, I²=21%) and cardiovascular (CV) mortality (pooled risk ratio = 1.23, 95% confidence interval: 0.64-2.39, p=.72, I²=35%).Conclusions: Previous CABG is not associated with either all-cause mortality or CV mortality in patients with severe AS undergoing TAVR. TAVR should be considered as an alternative or first-line treatment option among severe AS patient, regardless of previous CABG status.

Keywords: Coronary artery bypass; meta-analysis; mortality; systematic reviews; transcatheter aortic valve replacement.