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OBJECTIVE:
Transcatheter Aortic Valve Implantation (TAVI) is beneficial in high risk patients with severe aortic stenosis. Cardiac reoperations are more difficult and considered as an independant risk-factor for STS and Euroscore risk stratification models. We sought to determine the impact of previous cardiac operation as risk factor on outcomes after TAVI.
METHODS:
From 5/2008 to 10/2011, 213 Patients underwent TAVI at our institution. Indications, stratification (transfemoral and transapical) and excecution was done by a dedicated Heart-team. For analysis, patients were stratified by criteria of previous cardiac operation (Group 1 patients without and Group 2 with). Outcomes are presented according to Valve Academic Research Consortium (VARC) criteria.
RESULTS:
Patients demographics showed that patients without previous surgery had lower Euroscore (23±12 vs. 31±15%) and were older (83±6 vs. 77±8years) (p<0.05). 30-day mortality, myocardial infarction and stroke were similar in both groups (VARC). However, significantly more bleeding complications (VARC) occurred in Group 1. Table 1 summarizes outcomes.
CONCLUSIONS:
In our experience TAVI is safe for high risk patients with severe aortic stenosis. It appears that mortality after TAVI in patients with previous cardiac operations is lower than expected when comparing to the Euroscore. The possible role may be additional tissue stability which is present in the fibrotic scar tissue also leading to less bleeding complucations in these patients. Therefore we believe that TAVI is especially suitable in patients with previous cardiac operations.

VARC Outcomes

Outcomes	Group1 (n=155)	Group 2(n=58)	p=
30day mortality	15 (9.7%)	5 (8.6%)	ns
Myocardial Infarcrtion	3 (2%)	0	ns
Stroke	4 (3%)	2 (4%)	ns
Bleeding	23 (15%)	2 (4%)	<0.05