TAVR, SAVR Found to Be Safe for Patients with CABG History

JUNE 20, 2019
Patrick Campbell
doctor with patientA recent study has found that both transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) are safe for intermediate-risk patients with aortic stenosis and a history of coronary artery bypass graft (CABG) surgery.

Investigators examined more than 250 patients from the Surgical Replacement and Transcatheter Aortic Valve Implantation (SURTAVI) trial and found that, while both methods were safe, the transcatheter approach facilitated faster improvement in quality of life and better exercise capacity at the 1-year follow up. 

From the SURTAVI trial, investigators identified 1660 patients who underwent implantation and 273 that had undergone a CABG surgery in the past. Of those 273, 136 underwent attempted TAVR and 137 underwent attempted SAVR. 

The TAVR group was 81.6% (n=111) male and the mean age was 76.9 years. In the SAVR group, 85.4% (n=117) were male and the mean age was 76.7 years. The mean Society of Thoracic Surgeons Predicted Risk of Mortality score was 5.0% in the TAVR cohort and 5.2% in the SAVR cohort. 

The primary outcome of the analysis was all-cause mortality or disabling stroke at 10-year follow-up. Efficacy outcomes for the study included quality of life, which was measured using the Kansas City Cardiomyopathy Questionnaire at 30 days, 6 months, and 1 year, and distance walked in 6 minutes — this was measured using the 6-minute walk test at 30 days and 1 year. 

After analyses, investigators found that all-cause mortality or disabling stroke at 1-year follow-up did not differ between treatments (TAVR: 8.9%; 95% CI, 5.2-15.2; SAVR: 6.7%; 95% CI, 3.5-12.8; P = .53). Investigators noted that there was no significant difference in all-cause mortality or stroke at 30 days.

Several adverse events were more common at the 30-day follow-up in the SAVR group compared with TAVR. These events included stage 2 or 3 acute kidney injury and new or worsening atrial fibrillation. New permanent pacemakers were required more often in the TAVR cohort than the SAVR cohort. 

Compared with patients in the SAVR cohort, the mean Kansas City Cardiomyopathy Questionnaire summary score was significantly better among patents in the TAVR cohort at 30 days (81.4 [19.2] vs 69.7 [22.6]; P < .001) and treatments were similar at 1-year follow-up (85.7 [14.6] vs 82.8 [18.4]; P = .19). Additionally, patients in the TAVR group showed greater mean improvement in distance walked at 1 year (48.3 [120.6] m vs 16.8 [88.7] m; P = .04). 

Authors noted limitations within their study. The cohort examined only represents 16.4% of the total SURTAVI population and, because of this, firm conclusions could not be drawn. In their conclusion, authors noted that TAVR was associated with faster improvement in quality of life and a greater exercise tolerance.

This study, titled “Comparison of Outcomes After Transcatheter vs Surgical Aortic Valve Replacement Among Patients at Intermediate Operative Risk With a History of Coronary Artery Bypass Graft Surgery,” was published in JAMA Cardiology. 

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