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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 J+Cardiothorac+Surg
2014 ; 9
(ä): 99
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Propensity matched analysis of longterm outcomes following transcatheter based
aortic valve implantation versus classic aortic valve replacement in patients
with previous cardiac surgery
#MMPMID24915763
Papadopoulos N
; Schiller N
; Fichtlscherer S
; Lehmann R
; Weber CF
; Moritz A
; Doss M
; Zierer A
J Cardiothorac Surg
2014[Jun]; 9
(ä): 99
PMID24915763
show ga
BACKGROUND: The aim of this study was to compare outcome of patients with
previous cardiac surgery undergoing transapical aortic valve implantation
(Redo-TAVI) to those undergoing classic aortic valve replacement (Redo-AVR) by
using propensity analysis. METHODS: From January 2005 through May 2012, 52
high-risk patients underwent Redo-TAVI using a pericardial xenograft fixed within
a stainless steel, balloon-expandable stent (Edwards SAPIEN?). During the same
period of time 167 patients underwent classic Redo-AVR. Logistic regression
analysis was used to identify covariates among 11 baseline patient variables
including the type of initial surgery. Using the significant regression
coefficients, each patient's propensity score was calculated, allowing
selectively matched subgroups of 40 patients each. Initial surgery included
coronary artery bypass grafting in 30 patients, aortic valve replacement in 7
patients and mitral valve reconstruction in 3 patients in each group. Follow-up
was 4?±?2 years and was 100% complete. RESULTS: Postoperative chest tube drainage
(163?±?214 vs. 562?±?332 ml/24 h, p?=?0.02) and incidence of early permanent
neurologic deficit (0 vs. 13%, p?=?0.04) was lower in patients with Redo-TAVI and
there was a trend towards improved 30-day survival (p?=?0.06). Also we detected a
decreased ventilation time (p?=?0.04) and lower transfusion rate of allogenic
blood products (p???0.05) in the Redo-TAVI group. At late follow up differences
regarding incidence of major adverse events, including death and permanent
neurologic deficits (25% vs. 43%, p?=?0.01) statistically supported early
postoperative findings. CONCLUSION: The encouraging results regarding early and
long-term outcomes following TAVI in patients with previous cardiac surgery show,
that this evolving approach may be particularly beneficial in this patient
cohort.