Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 9, Number 1, February 2018, pages 40-45

Transcatheter Aortic Valve Replacement After Coronary Artery Bypass Graft Is Associated With Increased Pacemaker Implantation but Not Reduced Overall Survival

**Table 1.** Baseline Characteristics
	CABG (96)	No CABG (241)	P-value
Values are mean (standard deviation) or n (%).
Age	78.6 (7.99)	79.6 (9.16)	0.3679
Male sex	74 (77)	112 (46)	< 0.001
BMI	30.75 (5.84)	30.35 (6.38)	0.5963
Caucasian race	95 (99)	239 (99)	1.000
EuroSCORE (%)	12.89 (7.17)	6.92 (5.11)	< 0.001
STS risk score (%)	8.10 (4.77)	6.32 (3.69)	< 0.001
Preprocedural HTN	86 (90)	210 (87)	0.585
Preprocedural CAD	96 (100)	151 (63)	< 0.001
Baseline ejection fraction < 40%	16 (17)	30 (12)	0.379
Preprocedural NYHA Class III or IV symptoms	44 (46)	105 (44)	0.717
Preprocedural DM	40 (42)	80 (33)	0.166
Prior stroke/TIA	13 (14)	25 (10)	0.446
Preprocedural atrial fibrillation	33 (34)	70 (29)	0.360
Preprocedural serum creatinine (mg/dL)	1.20 (0.36)	1.28 (0.98)	0.414
Preprocedural eGFR < 60 mL/min	46 (48)	116 (48)	1.000
Preprocedural PAD	33 (34)	58 (24)	0.058
Preprocedural AAA	17 (18)	19 (8)	< 0.001
Preprocedural carotid artery stenosis > 50% or prior CEA	34 (35)	58 (24)	0.042
Prior PCI	37 (39)	87 (36)	0.708
Prior permanent pacemaker	14 (15)	26 (11)	0.353
Prior aortic valvuloplasty	14 (15)	44 (18)	0.522
Aspirin	84 (88)	174 (72)	0.003
ADP receptor inhibitor	30 (31)	77 (32)	1.000
Beta blocker	85 (88)	163 (68)	< 0.001
HMG-CoA reductase inhibitor	86 (90)	154 (64)	< 0.001
Any anticoagulant	24 (25)	60 (25)	1.000

Table 1. Baseline Characteristics

CABG (96)

No CABG (241)

P-value

Values are mean (standard deviation) or n (%).

Age

78.6 (7.99)

79.6 (9.16)

0.3679

Male sex

74 (77)

112 (46)

< 0.001

BMI

30.75 (5.84)

30.35 (6.38)

0.5963

Caucasian race

95 (99)

239 (99)

1.000

EuroSCORE (%)

12.89 (7.17)

6.92 (5.11)

< 0.001

STS risk score (%)

8.10 (4.77)

6.32 (3.69)

< 0.001

Preprocedural HTN

86 (90)

210 (87)

0.585

Preprocedural CAD

96 (100)

151 (63)

< 0.001

Baseline ejection fraction < 40%

16 (17)

30 (12)

0.379

Preprocedural NYHA Class III or IV symptoms

44 (46)

105 (44)

0.717

Preprocedural DM

40 (42)

80 (33)

0.166

Prior stroke/TIA

13 (14)

25 (10)

0.446

Preprocedural atrial fibrillation

33 (34)

70 (29)

0.360

Preprocedural serum creatinine (mg/dL)

1.20 (0.36)

1.28 (0.98)

0.414

Preprocedural eGFR < 60 mL/min

46 (48)

116 (48)

1.000

Preprocedural PAD

33 (34)

58 (24)

0.058

Preprocedural AAA

17 (18)

19 (8)

< 0.001

Preprocedural carotid artery stenosis > 50% or prior CEA

34 (35)

58 (24)

0.042

Prior PCI

37 (39)

87 (36)

0.708

Prior permanent pacemaker

14 (15)

26 (11)

0.353

Prior aortic valvuloplasty

14 (15)

44 (18)

0.522

Aspirin

84 (88)

174 (72)

0.003

ADP receptor inhibitor

30 (31)

77 (32)

1.000

Beta blocker

85 (88)

163 (68)

< 0.001

HMG-CoA reductase inhibitor

86 (90)

154 (64)

< 0.001

Any anticoagulant

24 (25)

60 (25)

1.000

**Table 2.** Procedural Characteristics
	CABG (n = 96)	No CABG (n = 241)	P-value
Values are mean (standard deviation) or n (%).
Approach
Transfermoral	78 (81)	195 (81)	1.000
Transapical	16 (17)	34 (14)	0.611
Transaortic	1 (1)	6 (2)	0.678
Trans-subclavian	0 (0)	6 (2)	0.189
Transcaval	1 (1)	0 (0)	0.285
Mean LOS after TAVR (days)	4.1 (5.04)	5.1 (7.91)	0.276
Valve type
First generation Sapien	25 (26)	67 (28)	0.788
Sapien XT	14 (15)	37 (15)	1.000
Sapien S3	35 (36)	78 (32)	0.523
First generation CoreValve	19 (20)	51 (21)	0.882
CoreValve Evolute	3 (3)	8 (3)	1.000
Mean valve size (mm)	26.4 (2.58)	25.7 (2.69)	0.0498

Table 2. Procedural Characteristics

CABG (n = 96)

No CABG (n = 241)

P-value

Values are mean (standard deviation) or n (%).

Approach

Transfermoral

78 (81)

195 (81)

1.000

Transapical

16 (17)

34 (14)

0.611

Transaortic

1 (1)

6 (2)

0.678

Trans-subclavian

0 (0)

6 (2)

0.189

Transcaval

1 (1)

0 (0)

0.285

Mean LOS after TAVR (days)

4.1 (5.04)

5.1 (7.91)

0.276

Valve type

First generation Sapien

25 (26)

67 (28)

0.788

Sapien XT

14 (15)

37 (15)

1.000

Sapien S3

35 (36)

78 (32)

0.523

First generation CoreValve

19 (20)

51 (21)

0.882

CoreValve Evolute

3 (3)

8 (3)

1.000

Mean valve size (mm)

26.4 (2.58)

25.7 (2.69)

0.0498

**Table 3.** Echocardiographic Data
	CABG	No CABG	P-value
Values are mean (standard deviation) or %.
Preprocedural aortic valve area (VTI) (cm²)	0.918 (0.300)	0.820 (0.227)	0.002
Preprocedural peak aortic velocity (cm/s)	395.1 (67.2)	426.2 (58.1)	< 0.001
Preprocedural peak aortic gradient (mm Hg)	64.2 (20.2)	74.3 (19.5)	< 0.001
Preprocedural mean aortic gradient (mm Hg)	40.9 (12.8)	46.7 (12.1)	< 0.001
Preprocedural ejection fraction (%)	55.1 (13.2)	58.7 (12.2)	0.017
Pre-procedural stroke volume (mL)	86.8 (19.3)	85.0 (21.2)	0.536
Preprocedural interventricular septum thickness (mm)	12.5 (2.5)	12.6 (2.5)	1.000
Preprocedural moderate aortic regurgitation (%)	22	19	0.877
Preprocedural severe aortic regurgitation (%)	4	4	1.000
Preprocedural moderate mitral regurgitation (%)	26	21	0.309
Preprocedural severe mitral regurgitation (%)	4	3	0.747
24 h post-TAVR aortic valve area (VTI) (cm²)	2.25 (0.709)	2.17 (0.630)	0.324
24 h post-TAVR peak aortic velocity (cm/s)	221.9 (65.7)	221.8 (51.4)	0.990
24 h post-TAVR peak aortic gradient (mm Hg)	21.1 (14.1)	20.8 (9.9)	0.831
24 h post-TAVR mean aortic gradient (mm Hg)	12.9 (8.8)	12.2 (5.9)	0.432
24 h post-TAVR ejection fraction (%)	57.9 (12.7)	62.7 (12.4)	0.002
24 h post-TAVR stroke volume (mL)	96.8 (27.4)	93.0 (27.9)	0.289
24 h post-TAVR moderate aortic regurgitation (%)	5	5	1.000
24 h post-TAVR moderate mitral regurgitation (%)	13	9	0.423
24 h post-TAVR severe mitral regurgitation (%)	3	2	0.412
1 year post-TAVR aortic valve area (VTI) (cm²)	2.07 (0.686)	1.96 (0.556)	0.306
1 year post-TAVR peak aortic velocity (cm/s)	225.7 (59.4)	218.2 (44.5)	0.397
1 year post-TAVR peak aortic gradient (mm Hg)	22.0 (12.3)	20.0 (8.9)	0.284
1 year post-TAVR mean aortic gradient (mm Hg)	12.2 (7.0)	11.6 (5.2)	0.530
1 year post-TAVR ejection fraction (%)	55.1 (13.5)	59.5 (12.6)	0.058
1 year post-TAVR stroke volume (mL)	96.7 (30.2)	91.5 (27.4)	0.320
1 year post-TAVR moderate aortic regurgitation (%)	8	15	0.302
1 year post-TAVR moderate mitral regurgitation (%)	10	13	0.791
1 year post-TAVR severe mitral regurgitation (%)	2	8	0.272

Table 3. Echocardiographic Data

CABG

No CABG

P-value

Values are mean (standard deviation) or %.

Preprocedural aortic valve area (VTI) (cm²)

0.918 (0.300)

0.820 (0.227)

0.002

Preprocedural peak aortic velocity (cm/s)

395.1 (67.2)

426.2 (58.1)

< 0.001

Preprocedural peak aortic gradient (mm Hg)

64.2 (20.2)

74.3 (19.5)

< 0.001

Preprocedural mean aortic gradient (mm Hg)

40.9 (12.8)

46.7 (12.1)

< 0.001

Preprocedural ejection fraction (%)

55.1 (13.2)

58.7 (12.2)

0.017

Pre-procedural stroke volume (mL)

86.8 (19.3)

85.0 (21.2)

0.536

Preprocedural interventricular septum thickness (mm)

12.5 (2.5)

12.6 (2.5)

1.000

Preprocedural moderate aortic regurgitation (%)

0.877

Preprocedural severe aortic regurgitation (%)

1.000

Preprocedural moderate mitral regurgitation (%)

0.309

Preprocedural severe mitral regurgitation (%)

0.747

24 h post-TAVR aortic valve area (VTI) (cm²)

2.25 (0.709)

2.17 (0.630)

0.324

24 h post-TAVR peak aortic velocity (cm/s)

221.9 (65.7)

221.8 (51.4)

0.990

24 h post-TAVR peak aortic gradient (mm Hg)

21.1 (14.1)

20.8 (9.9)

0.831

24 h post-TAVR mean aortic gradient (mm Hg)

12.9 (8.8)

12.2 (5.9)

0.432

24 h post-TAVR ejection fraction (%)

57.9 (12.7)

62.7 (12.4)

0.002

24 h post-TAVR stroke volume (mL)

96.8 (27.4)

93.0 (27.9)

0.289

24 h post-TAVR moderate aortic regurgitation (%)

1.000

24 h post-TAVR moderate mitral regurgitation (%)

0.423

24 h post-TAVR severe mitral regurgitation (%)

0.412

1 year post-TAVR aortic valve area (VTI) (cm²)

2.07 (0.686)

1.96 (0.556)

0.306

1 year post-TAVR peak aortic velocity (cm/s)

225.7 (59.4)

218.2 (44.5)

0.397

1 year post-TAVR peak aortic gradient (mm Hg)

22.0 (12.3)

20.0 (8.9)

0.284

1 year post-TAVR mean aortic gradient (mm Hg)

12.2 (7.0)

11.6 (5.2)

0.530

1 year post-TAVR ejection fraction (%)

55.1 (13.5)

59.5 (12.6)

0.058

1 year post-TAVR stroke volume (mL)

96.7 (30.2)

91.5 (27.4)

0.320

1 year post-TAVR moderate aortic regurgitation (%)

0.302

1 year post-TAVR moderate mitral regurgitation (%)

0.791

1 year post-TAVR severe mitral regurgitation (%)

0.272

**Table 4.** Primary and Secondary Outcomes
	CABG	No CABG	P-value
Values are % (n). MACCE: major adverse cardiovascular and cerebrovascular events, defined as death from any cause, myocardial infarction, rehospitalization, and stroke.
% Survival > 1 month	98 (94/96)	93 (225/241)	0.112
% Survival > 6 month	94 (78/83)	87 (163/188)	0.094
% Survival > 1 year	85 (58/68)	77 (119/154)	0.206
% Survival > 2 year	70 (29/41)	57 (59/104)	0.135
Periprocedural major vascular	6 (6)	10 (23)	0.394
Periprocedural minor vascular	7 (7)	10 (23)	0.672
Periprocedural blood transfusion	5 (5)	11 (27)	0.102
Post-TAVR PPM implantation	15 (14)	6 (14)	0.015
Periprocedural increase in serum creatinine > 1.5 × baseline	4 (4)	6 (15)	0.604
In hospital
CV mortality	3 (3)	6 (15)	0.298
Myocardial infarction	2 (2)	0 (0)	<.001
Stroke/TIA	0 (0)	3 (8)	0.111
HF exacerbation	14 (13)	24 (57)	0.052
Discharge to 30 days
MACCE	20 (19)	17 (38)	0.521
CV mortality	0 (0)	1 (0)	1.000
Myocardial infraction	1 (1)	1 (3)	1.000
Stroke/TIA	0 (0)	1 (3)	0.558
HF exacerbation	16 (15)	16 (36)	1.000
Rehospitalization for any reason	20 (19)	17 (37)	0.421
30 days - 6 months
MACCE	29 (23)	26 (44)	0.543
CV mortality	0 (0)	3 (5)	0.329
Myocardial infraction	3 (2)	1 (2)	0.592
Stroke/TIA	0 (0)	3 (5)	0.329
HF exacerbation	18 (14)	14 (24)	0.453
Rehospitalization for any reason	29 (23)	22 (37)	0.203
6 months -1 year
MACCE	33 (20)	29 (35)	0.607
CV mortality	3 (2)	2 (2)	0.602
Myocardial infraction	2 (1)	3 (3)	1.000
Stroke/TIA	2 (1)	1 (1)	1.000
HF exacerbation	17 (10)	21 (25)	0.554
Rehospitalization for any reason	30 (18)	27 (33)	0.728

Table 4. Primary and Secondary Outcomes

CABG

No CABG

P-value

Values are % (n). MACCE: major adverse cardiovascular and cerebrovascular events, defined as death from any cause, myocardial infarction, rehospitalization, and stroke.

% Survival > 1 month

98 (94/96)

93 (225/241)

0.112

% Survival > 6 month

94 (78/83)

87 (163/188)

0.094

% Survival > 1 year

85 (58/68)

77 (119/154)

0.206

% Survival > 2 year

70 (29/41)

57 (59/104)

0.135

Periprocedural major vascular

6 (6)

10 (23)

0.394

Periprocedural minor vascular

7 (7)

10 (23)

0.672

Periprocedural blood transfusion

5 (5)

11 (27)

0.102

Post-TAVR PPM implantation

15 (14)

6 (14)

0.015

Periprocedural increase in serum creatinine > 1.5 × baseline

4 (4)

6 (15)

0.604

In hospital

CV mortality

3 (3)

6 (15)

0.298

Myocardial infarction

2 (2)

0 (0)

<.001

Stroke/TIA

0 (0)

3 (8)

0.111

HF exacerbation

14 (13)

24 (57)

0.052

Discharge to 30 days

MACCE

20 (19)

17 (38)

0.521

CV mortality

0 (0)

1 (0)

1.000

Myocardial infraction

1 (1)

1 (3)

1.000

Stroke/TIA

0 (0)

1 (3)

0.558

HF exacerbation

16 (15)

16 (36)

1.000

Rehospitalization for any reason

20 (19)

17 (37)

0.421

30 days - 6 months

MACCE

29 (23)

26 (44)

0.543

CV mortality

0 (0)

3 (5)

0.329

Myocardial infraction

3 (2)

1 (2)

0.592

Stroke/TIA

0 (0)

3 (5)

0.329

HF exacerbation

18 (14)

14 (24)

0.453

Rehospitalization for any reason

29 (23)

22 (37)

0.203

6 months -1 year

MACCE

33 (20)

29 (35)

0.607

CV mortality

3 (2)

2 (2)

0.602

Myocardial infraction

2 (1)

3 (3)

1.000

Stroke/TIA

2 (1)

1 (1)

1.000

HF exacerbation

17 (10)

21 (25)

0.554

Rehospitalization for any reason

30 (18)

27 (33)

0.728