The impact of coronary artery bypass grafting added to aortic valve replacement on long-term outcomes in octogenarian patients: a reconstructed time-to-event meta-analysis.
Alan GallinganiStefano D'AlessandroGurmeet SinghDaniel Hernández-VaqueroMevlüt ÇelikEvelina CeccatoFrancesco NicoliniFrancesco FormicaPublished in: Interactive cardiovascular and thoracic surgery (2022)
The long-term results in studies comparing octogenarian patients who received either isolated surgical aortic valve replacement (i-SAVR) or coronary artery bypass grafting (CABG) in addition to SAVR are still debated. We performed a reconstructed time-to-event data meta-analysis of studies comparing i-SAVR and CABG+SAVR to evaluate the impact of CABG and to analyse the time-varying effects on long-term outcome. We performed a systematic review of the literature from January 2000 through November 2021, including studies comparing i-SAVR and CABG+SAVR, which reported at least 3-year follow-up and that plotted Kaplan-Meier curves of overall survival. The primary endpoint was overall long-term survival; secondary endpoints were in-hospital/30-day mortality and postoperative outcomes. The pooled hazard ratio (HR) and odds ratio) with 95% confidence interval (CI) were calculated for primary and secondary endpoints, respectively. Random-effect model was used in all analyses. Sixteen retrospective studies were included (5382 patients, i-SAVR = 2568 and CABG+SAVR = 2814). I-SAVR showed a lower incidence of in-hospital mortality compared to CABG+SAVR (odds ratio = 0.73; 95% CI= 0.60-0.89; P = 0.002). Landmark analyses showed a significantly higher all-cause mortality within 1 year from surgery in CABG+SAVR (HR = 1.17; 95% CI = 1.01-1.36; P = 0.03); after 1 year, no significant difference was observed (HR = 0.95; 95% CI = 0.87-1.04; P = 0.35). Landmark analysis was confirmed by time-varying trend of HR. Late survival of octogenarians did not differ significantly between the 2 interventions. Interestingly, CABG added to SAVR was associated with both higher in-hospital and within 1-year mortality after surgery, whereas this difference was statistically non-significant at long-term follow-up.
Keyphrases
- coronary artery bypass grafting
- coronary artery disease
- percutaneous coronary intervention
- aortic valve replacement
- coronary artery bypass
- ejection fraction
- case control
- aortic stenosis
- systematic review
- end stage renal disease
- newly diagnosed
- cardiovascular events
- transcatheter aortic valve implantation
- healthcare
- aortic valve
- acute coronary syndrome
- type diabetes
- physical activity
- clinical trial
- metabolic syndrome
- minimally invasive
- emergency department
- deep learning
- adipose tissue
- atrial fibrillation
- adverse drug
- big data
- patient reported
- drug induced
- childhood cancer