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Comparison of outcomes after transcatheter vs surgical aortic valve replacement among patients at intermediate operative risk with a history of coronary artery bypass graft surgery: A post hoc analysis of the SURTAVI randomized clinical trial

JAMA Cardiology Aug 29, 2019

Reardon MJ, Heijmen RH, Van Mieghem NM, et al. - In this post hoc analysis of the Surgical Replacement and Transcatheter Aortic Valve Implantation (SURTAVI) noninferiority randomized clinical trial, researchers compared outcomes of transcatheter aortic valve replacement (TAVR) with those of surgical aortic valve replacement (SAVR) in patients at intermediate operative risk with prior coronary artery bypass graft (CABG) surgery. The participants were recruited from 87 centers across the United States, Europe, and Canada. Randomization of 1,746 patients (1:1) to self-expanding TAVR or SAVR was done. All-cause mortality or disabling stroke at 1-year follow-up was the primary outcome. In the TAVR cohort and in the SAVR cohort, the mean (SD) Society of Thoracic Surgeons Predicted Risk of Mortality score was 5.0% (1.6%) and 5.2% (1.7%) and the all-cause mortality or disabling stroke at 1-year follow-up was 8.9% and 6.7%, respectively. Overall, findings revealed the safety of both TAVR and SAVR for intermediate-risk patients with aortic stenosis and prior CABG surgery. With the transcatheter approach, a faster improvement in quality of life was facilitated and better exercise capacity at 1-year follow-up was achieved.
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