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Redo-aortic Valve Replacement Versus TAVR In Patients With Patent Grafts
Renzo Pessotto, Neal Uren, Andrew Flapan, Sai Prasad, David Northridge, Kirsty Stewart.
Edinburgh Royal Infirmary, Edinburgh, United Kingdom.

OBJECTIVE: Transcatheter aortic valve replacement (TAVR) has been shown to be successful in high risk patients while redo-aortic valve surgery (redo-AVR) in patients with previous coronary artery bypass grafting (CABG) and patent grafts carries a high mortality. To define the best treatment strategy for this cohort of patients, we reviewed our experince with TAVR and redo-AVR at the Edinburgh heart Centre.
METHODS: From January 2011 to December 2013, 86 consecutive patients underwent either TAVR(43) or redo-AVR(43) at our Insitution. All inoperable patients and those considered too high risk for redo-AVR underwent TAVR.Outcomes were prospectively collected.
RESULTS: TAVR patients were significantly older (mean age 80 yrs vs 73) and had a higher logistic euroscore (30.9 vs 9.4). The 30-day mortality
(4.6 % vs 7 %)
and the incidence of debilitating strokes (2.3 vs 4.6 %) were significantly lower in TAVR. Following the procedure, TAVR pts had significantly shorter ITU (2.3 vs 6.2 days) and hospital stays (4.5 vs 18 days)
CONCLUSIONS: TAVR should be considered in all patients with severe AS and patent grafts. Redo-AVR should be considered in younger pts in whom durability of the TAVR might be a concern or whenTAVR is not feasible.

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