Background and aim of the study: Surgical aortic valve replacement remains the 'gold standard' treatment for aortic valve disease. An increasing number of elderly patients with multiple comorbidities are referred for transcatheter aortic valve implantation (TAVI), partly due to the perceived high risks of surgery. These include in particular patients who have had previous cardiac surgery. The study aim was to compare the outcomes of patients with aortic valve disease and previous cardiac surgery who underwent TAVI, with those who had redo surgery.
Methods: Patients were identified with aortic valve disease and previous cardiac surgery referred to the authors' multidisciplinary meeting. Patient characteristics were noted, together with their allocation to either re-do surgery or TAVI. A total of 20 patients who had undergone previous cardiac surgery was allocated to TAVI; these were matched to 20 patients who had undergone previous surgery and subsequently had redo surgery. Treatment modalities were chosen for individual patients according to their EuroSCORE, together with other factors not accounted for in traditional scoring systems.
Results: Between June 2008 and March 2010, a total of 191 patients was discussed; of these patients, 63 underwent TAVI, 20 of whom had undergone previous cardiac surgery. There was no significant difference in the EuroSCORE between groups (18 +/- 2 versus 19 +/- 3.0, p = 0.91). TAVI patients had a higher body mass index (27.1 +/- 3.9 versus 21.8 +/- 0.5 kg/m2, p = 0.0001). There were no deaths at 30 days in either group. One patient (5%) in the TAVI group had a transient ischemic attack following the procedure, and one (5%) had a hematoma at the site of arterial puncture. There were more pacemaker implantations in the TAVI group than in the redo group (25% versus 0%, p = 0.02).
Conclusion: Improved risk stratification and its understanding in patients with aortic valve disease and previous cardiac surgery is required. Despite the perceived high risks in the surgically treated group, there were no deaths and redo surgery patients had lower rates of stroke and pacemaker implantation than did those who underwent TAVI.