Universität zu Köln

Scherner, Maximilian, Madershahian, Navid, Kuhr, Kathrin, Rosenkranz, Stephan, Stoeger, Elisabeth, Rahmanian, Parwis, Choi, YeongHoon, Slottosch, Ingo, Wippermann, Jens, Strauch, Justus and Wahlers, Thorsten (2014). Aortic valve replacement after previous heart surgery in high-risk patients: Transapical aortic valve implantation versus conventional aortic valve replacement-a risk-adjusted and propensity score-based analysis. J. Thorac. Cardiovasc. Surg., 148 (1). S. 90 - 98. NEW YORK: MOSBY-ELSEVIER. ISSN 1097-685X

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Abstract

Objective: Cardiac reoperations have been associated with increased morbidity and mortality compared with first-time surgery. We analyzed our experience with reoperative aortic valve replacement (redo-AVR) and compared these results with those from patients who had undergone transapical aortic valve implantation (TA-AVI) as a second heart operation. Methods: In the present retrospective observational comparative study, we analyzed the outcome of 136 patients with previous cardiac surgery who had undergone conventional redo-AVR (n=59; since 2006) or TA-AVI (n=77; since 2008) with respect to the 30-day outcomes (Valve Academic Research Consortium criteria), 1-and 3-year survival, and the risk factors for both approaches after previous heart surgery. Results: Neither group differed significantly in their risk profile, leading to similar Society of Thoracic Surgeon score and EuroSCORE. The 30-day mortality was 3.39%(n=2) in the redo-AVR group and 7.8%(n=6) in the redo TA-AVI group (P=.465). The overall combined safety endpoint at 30 days was significantly lower for the TA-AVI patients (18.1% vs 33.9% in redo-AVR; P=.036). The unadjusted and adjusted 1-year survival showed no difference between the 2 groups. The unadjusted 3-year survival revealed a 2.1-fold greater mortality risk after TA-AVI (P=.055). Adjustment by multivariate Cox regression analysis (hazard ratio, 1.427; 95% confidence interval, 0.635-3.209; P=.389) and propensity score (hazard ratio, 1.571; 95% confidence interval, 0.575-4.291; P=.378) led to a >50% risk reduction, resulting in similar 3-year survival in the 2 groups. Conclusions: Redo-AVR can be performed with acceptable results in high-risk patients and still serves as the reference standard. Reoperative valve surgery by TA-AVI is feasible and results in comparable short-and mid-term survival.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Scherner, Maximilian UNSPECIFIED UNSPECIFIED UNSPECIFIED Madershahian, Navid UNSPECIFIED UNSPECIFIED UNSPECIFIED Kuhr, Kathrin UNSPECIFIED UNSPECIFIED UNSPECIFIED Rosenkranz, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED Stoeger, Elisabeth UNSPECIFIED UNSPECIFIED UNSPECIFIED Rahmanian, Parwis UNSPECIFIED UNSPECIFIED UNSPECIFIED Choi, YeongHoon UNSPECIFIED UNSPECIFIED UNSPECIFIED Slottosch, Ingo UNSPECIFIED UNSPECIFIED UNSPECIFIED Wippermann, Jens UNSPECIFIED UNSPECIFIED UNSPECIFIED Strauch, Justus UNSPECIFIED UNSPECIFIED UNSPECIFIED Wahlers, Thorsten UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-434285
DOI:	10.1016/j.jtcvs.2013.07.046
Journal or Publication Title:	J. Thorac. Cardiovasc. Surg.
Volume:	148
Number:	1
Page Range:	S. 90 - 98
Date:	2014
Publisher:	MOSBY-ELSEVIER
Place of Publication:	NEW YORK
ISSN:	1097-685X
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language Cardiac & Cardiovascular Systems; Respiratory System; Surgery Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/43428