Coronary Artery Disease in Patients Undergoing Transvalvular Aortic Valve Implantation

Lim, Yinghao; Tan, Kent Anthony; Kuntjoro, Ivandito; Hon, Jimmy Kim Fatt; Yip, James; Tay, Edgar

doi:10.15420/icr.2021.25

Cited by 3 publications

(3 citation statements)

References 99 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The existence of CAD was correlated with an escalated mortality risk following TAVR, in line with multiple studies demonstrating the adverse impact of CAD on procedural outcomes and long-term survival [ 11 , 12 ]. In contrast, a history of CABG before TAVR was found to be protective against mortality.…”

Section: Discussionsupporting

confidence: 66%

Long-Term Prognosis and Predictors of Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement: A Retrospective Analysis

Thogata,

Garikipati,

Reddy S

et al. 2023

Cureus

View full text Add to dashboard Cite

Background: Aortic valve disease is a common and impactful disorder that imposes significant health burdens and is associated with increased mortality rates. Particularly noteworthy is the emergence of transcatheter aortic valve replacement (TAVR), a minimally invasive procedure that has revolutionized the management of aortic valve disease. However, there remain certain unresolved questions and ongoing research regarding the long-term effectiveness and suitability of TAVR in various patient populations, underscoring the need for further investigation and clinical scrutiny. Objective: This retrospective analysis aimed to investigate the long-term outcomes and predictors of mortality in 500 patients who underwent transcatheter aortic valve replacement (TAVR). Methods: This retrospective analysis included individuals who received transcatheter aortic valve replacement (TAVR) at Sri Venkata Sai (SVS) Medical College, Mahabubnagar, Telangana, India, between January 2020 and July 2023. Demographic characteristics, including age, gender, and comorbidities, were recorded, and long-term outcomes after TAVR were assessed, including the incidence of survival rates and major adverse cardiac events (MACE). Predictors of mortality were also identified using Cox proportional hazards regression analysis. Results: The study group exhibited an average age of 75.6 years (standard deviation (SD): 6.8), with 58% male and 42% female patients. Hypertension (74%), coronary artery disease (CAD) (68%), diabetes mellitus (DM) (42%), and chronic kidney disease (CKD) stage ≥ 3 (36%) were prevalent comorbidities. The median follow-up duration was 5.2 years (interquartile range (IQR): 4.3-6.8 years). The overall long-term survival rate after TAVR was 73.5% (95% confidence interval (CI): 69.8%-77.1%). Additionally, MACE occurred in 21% of patients throughout the follow-up period. The cumulative incidence of MACE at one year, three years, and five years was 6.8% (95% CI: 4.2%-9.5%), 14.2% (95% CI: 10.6%-18.7%), and 21.8% (95% CI: 17.3%-26.7%), respectively. The study found that higher age (hazard ratio (HR): 1.08, 95% CI: 1.04-1.12, p < 0.001), male gender (HR: 1.48, 95% CI: 1.15-1.91, p = 0.002), and the presence of CAD (HR: 1.72, 95% CI: 1.29-2.30, p < 0.001) were linked to an elevated risk of mortality. Additionally, diabetes mellitus (HR: 1.39, 95% CI: 1.05-1.85, p = 0.022) and CKD stage ≥ 3 (HR: 1.96, 95% CI: 1.47-2.61, p < 0.001) emerged as notable predictors of mortality. Conversely, a history of prior coronary artery bypass grafting (CABG) (HR: 0.62, 95% CI: 0.46-0.84, p = 0.003) was associated with a reduced risk of mortality. No significant associations were found between mortality and hypertension (HR: 1.12, 95% CI: 0.88-1.43, p = 0.360) or prior percutaneous coronary intervention (PCI) (HR: 1.21, 95% CI: 0.88-1.67, p = 0.245). Conclusion: Age, male gender, CAD, DM, and CKD stage ≥ 3 were significant indicators of mortality risk in TAVR patients. Risk stratification and individualized...

show abstract

Section: Discussionsupporting

confidence: 66%

Long-Term Prognosis and Predictors of Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement: A Retrospective Analysis

Thogata,

Garikipati,

Reddy S

et al. 2023

Cureus

View full text Add to dashboard Cite

show abstract

“…The clinical and prognostic role of coronary artery lesions in patients undergoing TAVI remains controverse and evidence are limited and still debated ( 3 , 9 – 14 ). The bottom line is that CAD has been associated with a shorter survival rate in patients undergoing TAVI ( 15 , 16 ). Percutaneous coronary intervention (PCI) and subsequent dual antiplatelet therapy (DAPT) are burdened with several complications and an increased bleeding risk, especially in elderly patients treated with TAVI ( 17 ).…”

Section: Introductionmentioning

confidence: 99%

“…Recent advances in coronary physiology have shown that QFR has a good diagnostic performance compared to Fractional Flow Reserve (FFR) and it is superior compared to angiography alone and safer in assessing the functional relevance of coronary lesions ( 30 ), even in TAVI patients ( 16 , 31 ). The optimal approach was validated in the FAVOR (Functional Assessment by Various Flow Reconstructions) study saga, proving the reliability of QFR ( 30 ) and its superiority to angiographic assessment for evaluation of intermediary coronary artery stenosis, using FFR as a reference standard ( 32 ).…”

Section: Introductionmentioning

confidence: 99%

Quantitative flow ratio-based outcomes in patients undergoing transcatheter aortic valve implantation quaestio study

Demola,

Colaiori,

Bosi

et al. 2023

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

BackgroundCoronary artery disease (CAD) is common in patients with aortic valve stenosis (AS) ranging from 60% to 80%. The clinical and prognostic role of coronary artery lesions in patients undergoing Transcatheter Aortic Valve Implantation (TAVI) remains unclear. The aim of the present observational study was to estimate long-term clinical outcomes by Quantitative Flow Ratio (QFR) characterization of CAD in a well-represented cohort of patients affected by severe AS treated by TAVI.MethodsA total of 439 invasive coronary angiographies of patients deemed eligible for TAVI by local Heart Teams with symptomatic severe AS were retrospectively screened for QFR analysis. The primary endpoint of the study was all-cause mortality. The secondary endpoint was a composite of cardiovascular mortality, stroke/transient ischemic attack (TIA), acute myocardial infarction (AMI), and any hospitalization after TAVI.ResultsAfter exclusion of patients with no follow-up data, coronary angiography not feasible for QFR analysis and previous surgical myocardial revascularization (CABG) 48/239 (20.1%) patients had a QFR value lower or equal to 0.80 (QFR + value), while the remaining 191/239 (79.9%) did not present any vessel with a QFR positive value. In the adjusted Cox regression analysis, patients with positive QFR were independently associated with an increased risk of all-casual mortality (Model 1, HR 3.47, 95% CI, 2.35−5.12; Model 2, HR 5.01, 95% CI, 3.17−7.90). In the adjusted covariate analysis, QFR+ involving LAD (37/48, 77,1%) was associated with the higher risk of the composite outcome compared to patients without any positive value of QFR or non-LAD QFR positive value (11/48, 22.9%).ConclusionsPre-TAVI QFR analysis can be used for a safe, simple, wireless functional assessment of CAD. QFR permits to identify patients at high risk of cardiovascular mortality or MACE, and it could be considered by local Heart Teams.

show abstract

Evaluation and management of coronary artery disease in patients undergoing transcatheter aortic valve implantation

Raval,

Gordon

2024

Vessel Plus

View full text Add to dashboard Cite

Significant coronary artery disease (CAD) and severe aortic stenosis (AS) are frequent findings in patients who undergo transcatheter aortic valve implantation (TAVI). With the extension of TAVI in patients who have intermediate and even low surgical risk, the optimal evaluation and management of concomitant CAD needs to be determined. Both pre-TAVI evaluation of CAD and indications for revascularization remain a matter of debate. In this review, we provide an updated overview of the prevailing landscape of CAD in patients undergoing TAVI with a focus on its prognostic impact, diagnostic evaluation pre-procedure, indications for revascularization, optimal timing of revascularization, and future directions.

show abstract

Coronary Artery Disease in Patients Undergoing Transvalvular Aortic Valve Implantation

Cited by 3 publications

References 99 publications

Long-Term Prognosis and Predictors of Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement: A Retrospective Analysis

Long-Term Prognosis and Predictors of Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement: A Retrospective Analysis

Quantitative flow ratio-based outcomes in patients undergoing transcatheter aortic valve implantation quaestio study

Evaluation and management of coronary artery disease in patients undergoing transcatheter aortic valve implantation

Contact Info

Product

Resources

About