Coronary revascularization after surgical aortic valve replacementCentral MessagePerspective
Objective: It remains unclear how often coronary revascularization is necessary after aortic valve interventions, either by surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement. However, these data are relevant for treatment and prosthesis choice. The authors sought to...
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| Format: | Article |
| Language: | English |
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Elsevier
2020-09-01
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| Series: | JTCVS Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666273620300383 |
| _version_ | 1818308986955366400 |
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| author | Mevlüt Çelik, BSc Andras P. Durko, MD Stuart J. Head, MD, PhD Edris A.F. Mahtab, MD, PhD Nicolas M. van Mieghem, MD, PhD Paul A. Cummins, MSc Arie P. Kappetein, MD, PhD Ad.J.J.C. Bogers, MD, PhD |
| author_facet | Mevlüt Çelik, BSc Andras P. Durko, MD Stuart J. Head, MD, PhD Edris A.F. Mahtab, MD, PhD Nicolas M. van Mieghem, MD, PhD Paul A. Cummins, MSc Arie P. Kappetein, MD, PhD Ad.J.J.C. Bogers, MD, PhD |
| author_sort | Mevlüt Çelik, BSc |
| collection | DOAJ |
| description | Objective: It remains unclear how often coronary revascularization is necessary after aortic valve interventions, either by surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement. However, these data are relevant for treatment and prosthesis choice. The authors sought to analyze the incidence and characteristics of coronary revascularization after SAVR during follow-up. Methods: Of 2256 patients undergoing isolated SAVR between 1987 and 2015, 420 patients (mean age 56.9 ± 15.5 years, 66.9% male) were followed at the Erasmus Medical Center. Incidence, predictors, and characteristics of coronary revascularization were analyzed. Cumulative incidence of revascularization was assessed using a competing risk approach. Results: Mean follow-up after SAVR was 17.2 years (total of 4541 patient-years). A total of 24 patients underwent 28 procedures of revascularization. The cumulative incidence of revascularization after SAVR was 0.5%, 2.2%, 4.1%, and 6.9% at 1, 5, 10, and 20 years, respectively. The linearized rate of revascularization was 6.2 per 1000 patient-years. Percutaneous coronary intervention was the most common revascularization method (64%; N = 18/28). Revascularization before SAVR (N = 36/420; of whom 27 percutaneous coronary intervention) was an independent predictor of revascularization during follow-up (hazard ratio, 6.6; 95% confidence interval, 2.6-17.1; P < .001). Conclusions: After SAVR, the rate of coronary revascularization was 6.9% (N = 24/420) at 20-year follow-up. Patients were at particular risk if they had undergone previous revascularization before SAVR. These data may furthermore be relevant to the transcatheter aortic valve replacement population. |
| first_indexed | 2024-12-13T07:23:00Z |
| format | Article |
| id | doaj.art-edf6b6a81f134c2cb138ed2f84a9facc |
| institution | Directory Open Access Journal |
| issn | 2666-2736 |
| language | English |
| last_indexed | 2024-12-13T07:23:00Z |
| publishDate | 2020-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Open |
| spelling | doaj.art-edf6b6a81f134c2cb138ed2f84a9facc2022-12-21T23:55:22ZengElsevierJTCVS Open2666-27362020-09-01391101Coronary revascularization after surgical aortic valve replacementCentral MessagePerspectiveMevlüt Çelik, BSc0Andras P. Durko, MD1Stuart J. Head, MD, PhD2Edris A.F. Mahtab, MD, PhD3Nicolas M. van Mieghem, MD, PhD4Paul A. Cummins, MSc5Arie P. Kappetein, MD, PhD6Ad.J.J.C. Bogers, MD, PhD7Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The NetherlandsDepartment of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The NetherlandsDepartment of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands; Medtronic, Maastricht, The NetherlandsDepartment of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands; Address for reprints: Edris A. F. Mahtab, MD, PhD, Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands.Department of Cardiology, Erasmus University Medical Center, Rotterdam, The NetherlandsDepartment of Cardiology, Erasmus University Medical Center, Rotterdam, The NetherlandsDepartment of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands; Medtronic, Maastricht, The NetherlandsDepartment of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The NetherlandsObjective: It remains unclear how often coronary revascularization is necessary after aortic valve interventions, either by surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement. However, these data are relevant for treatment and prosthesis choice. The authors sought to analyze the incidence and characteristics of coronary revascularization after SAVR during follow-up. Methods: Of 2256 patients undergoing isolated SAVR between 1987 and 2015, 420 patients (mean age 56.9 ± 15.5 years, 66.9% male) were followed at the Erasmus Medical Center. Incidence, predictors, and characteristics of coronary revascularization were analyzed. Cumulative incidence of revascularization was assessed using a competing risk approach. Results: Mean follow-up after SAVR was 17.2 years (total of 4541 patient-years). A total of 24 patients underwent 28 procedures of revascularization. The cumulative incidence of revascularization after SAVR was 0.5%, 2.2%, 4.1%, and 6.9% at 1, 5, 10, and 20 years, respectively. The linearized rate of revascularization was 6.2 per 1000 patient-years. Percutaneous coronary intervention was the most common revascularization method (64%; N = 18/28). Revascularization before SAVR (N = 36/420; of whom 27 percutaneous coronary intervention) was an independent predictor of revascularization during follow-up (hazard ratio, 6.6; 95% confidence interval, 2.6-17.1; P < .001). Conclusions: After SAVR, the rate of coronary revascularization was 6.9% (N = 24/420) at 20-year follow-up. Patients were at particular risk if they had undergone previous revascularization before SAVR. These data may furthermore be relevant to the transcatheter aortic valve replacement population.http://www.sciencedirect.com/science/article/pii/S2666273620300383aortic stenosisaortic valve replacementtranscathetercoronary artery bypass graftingpercutaneous coronary intervention |
| spellingShingle | Mevlüt Çelik, BSc Andras P. Durko, MD Stuart J. Head, MD, PhD Edris A.F. Mahtab, MD, PhD Nicolas M. van Mieghem, MD, PhD Paul A. Cummins, MSc Arie P. Kappetein, MD, PhD Ad.J.J.C. Bogers, MD, PhD Coronary revascularization after surgical aortic valve replacementCentral MessagePerspective JTCVS Open aortic stenosis aortic valve replacement transcatheter coronary artery bypass grafting percutaneous coronary intervention |
| title | Coronary revascularization after surgical aortic valve replacementCentral MessagePerspective |
| title_full | Coronary revascularization after surgical aortic valve replacementCentral MessagePerspective |
| title_fullStr | Coronary revascularization after surgical aortic valve replacementCentral MessagePerspective |
| title_full_unstemmed | Coronary revascularization after surgical aortic valve replacementCentral MessagePerspective |
| title_short | Coronary revascularization after surgical aortic valve replacementCentral MessagePerspective |
| title_sort | coronary revascularization after surgical aortic valve replacementcentral messageperspective |
| topic | aortic stenosis aortic valve replacement transcatheter coronary artery bypass grafting percutaneous coronary intervention |
| url | http://www.sciencedirect.com/science/article/pii/S2666273620300383 |
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