In patients who have previously undergone coronary artery bypass graft surgery (CABG), surgical aortic valve replacement (SAVR) can be a complicated procedure due to the risks of sternal re-entry and cardiac or graft injury. Transcatheter aortic valve replacement (TAVR) offers a less invasive approach that may be more optimal in this patient population. The Surgical Replacement and Transcatheter Aortic Valve Implantation (SURTAVI) trial assigned 1,746 patients with severe, symptomatic aortic stenosis to either SAVR or TAVR and found that TAVR was noninferior to surgery in the primary endpoint of a composite of death from any cause or disabling stroke at 2 years. In this secondary post-hoc analysis of the SURTAVI randomized controlled trial, 273 patients who had undergone prior CABG surgery, including 136 who underwent TAVR and 137 who underwent SAVR, were studied to compare the primary outcome of all-cause mortality or disabling stroke at 1-year follow-up. At baseline, 81.6% of patients in the TAVR cohort and 85.4% of patients in the SAVR cohort were male. Researchers found that there was no difference in the primary outcome between the two groups at 1-year follow up (p=0.53). Patients in the TAVR group did, however, report a better quality of life at 30 days (as measured by the mean Kansas City Cardiomyopathy Questionnaire summary score) than those in the SAVR group (p<0.001). Moreover, patients in the TAVR group had better exercise capacity at 1 year (as determined by the 6-minute walk test) than those in the SAVR group (p=0.04). In summary, this study suggests that both SAVR and TAVR are safe in patients with prior CABG surgery, and that TAVR leads to a more rapid improvement in quality of life and exercise tolerance in these patients, supporting its use in this patient group.
Click to read the study in JAMA Cardiology
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