CRT-700.09 Early Outcomes and Peri-Procedural Complications of Transcatheter Aortic Valve Replacement in Patients With Previous Coronary Artery Bypass Graft Surgery

Abstract

Background: Patients who underwent a previous coronary artery bypass graft (CABG) surgery are at increased peri-operative risk when undergoing a redo cardiac operation such as Transcatheter Aortic Valve Replacement (TAVR). Recent studies have showed no risk difference in 30-day mortality and conflicting data with respect to periprocedural complications. We performed a systematic review and meta-analysis to compare the early outcomes and peri-procedural complications of TAVR in patients with or without previous CABG. Method(s): A search was made in the PubMed and Cochrane databases using the search terms "TAVR" and "CABG". The major outcomes were 30-day mortality and peri-procedural complications. We used random effects model to perform statistical analyses. Result(s): A total of 9 studies (6441 patients) were included, of which 6 studies reported 30-day mortality. Compared to patients without previous CABG, patients with previous CABG undergoing TAVR had no difference in terms of risk of 30-day mortality (RR: 0.67; 95% CI: 0.36-1.25; p = 0.21), Periprocedural mortality (RR: 0.78; 95% CI: 0.38-1.60; p = 0.49), Stroke (RR: 0.76; 95% CI: 0.54-1.07; p = 0.12), AKI (RR: 0.98; 95% CI: 0.71-1.36; p = 0.92), Cardiac tamponade (RR: 0.82; 95% CI: 0.26-2.58; p = 0.74), Aortic regurgitation (RR: 0.79; 95% CI: 0.63-1.00; p = 0.05). Patients with previous CABG had lower risk of Vascular complications (RR: 0.76; 95% CI: 0.62-0.95; p = 0.01), Bleeding (RR: 0.67; 95% CI: 0.53-0.86; p = 0.001), and higher risk of MI (RR: 1.98; 95% CI: 1.17-3.34; p = 0.01) and Pacemaker implantation (RR: 1.19; 95% CI: 1.03-1.39; p = 0.02). Conclusion(s): Patients with or without previous CABG undergoing TAVR had mostly similar outcomes with exception of vascular complications, bleeding, MI, and pacemaker implantation. These factors should be considered while planning for TAVR in such patients. [Formula presented]Copyright © 2022