Safety and effectiveness of a selective strategy for coronary artery revascularization before transcatheter aortic valve implantation

Authors


  • Conflict of interest: Prof. Gino Gerosa and Dr. G. Isabella are physician proctor for Edwards Lifesciences Company.

Correspondence to: Valeria Gasparetto, MD, Division of Cardiology, Department of Cardiac Thoracic and Vascular Sciences, University of Padova, 2 via Giustiniani, 35100, Padova, Italy. E-mail: gasparetto.valeria@gmail.com

Abstract

Objectives

We assessed the safety and effectiveness of a selective percutaneous revascularization strategy before TAVI in a single-center prospective registry.

Background

Management of Coronary Artery Disease (CAD) before Transcatheter Aortic Valve Implantation (TAVI) is not yet established.

Methods

Percutaneous Coronary Intervention (PCI) was scheduled in proximal-to-mid coronary segment lesions on major coronary branches. TAVI was performed by percutaneous trans-femoral, trans-subclavian or trans-apical approach, using either the self-expandable III generation CoreValve (Medtronic, Minneapolis, Minnesota USA) or the Edwards SAPIEN/SAPIEN XT balloon-expandable prosthesis (Edwards Lifesciences Irvine, CA). Clinical and echocardiographic follow-up was collected at 30-day, 3,6,12-month and yearly thereafter.

Results

Out of 191 patients who underwent TAVI, 113 (59.2%) had CAD. Mean age was 80.5 ± 6.9 years (57.6% female), logistic EuroSCORE was 21.4% ± 13.4. Twenty-seven (14.1%) patients had previous percutaneous and 29 (15.2%) surgical revascularization. PCI was performed as scheduled before TAVI in 39 (20.4%) patients, without adverse events. Complete anatomical revascularization was obtained in 38 of 113 CAD patients (33.6%). After TAVI, 30-day mortality was 4.2%, and was comparable between CAD and no-CAD patients (P = ns), while 30-day myocardial infarction incidence was 2.6% and occurred only in the CAD group (4.4%, P = 0.06). Overall mortality at follow-up (12.9 ± 9.5 months) was 14.8%, without difference between groups (P = 0.88). At follow-up, five patients underwent coronary revascularization.

Conclusions

In this study, the incidence of CAD is high in patients referred for TAVI. A selective, clinical based, coronary revascularization before TAVI seemed to be safe, and was associated with an outcome similar to those observed in no-CAD TAVI patients. © 2012 Wiley Periodicals, Inc.

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