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

Gasparetto, Valeria; Fraccaro, Chiara; Tarantini, Giuseppe; Buja, Paolo; D’Onofrio, Augusto; Yzeiraj, Ermela; Pittarello, Demetrio; Isabella, G; Gerosa, Gino; Iliceto, Sabino; Napodano, Massimo

doi:10.1002/ccd.24434

Cited by 90 publications

(52 citation statements)

References 19 publications

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“…We performed a retrospective analysis of the Padua University REVALVing Experience (PUREVALVE) registry, in which data on all patients undergoing TAVR at our Institution since June 2007 was prospectively collected (13)(14)(15). Our study focused on 171 consecutive patients treated between June 2007 and December 2010, who were therefore eligible at least for a 5-year followup.…”

Section: Study Populationmentioning

confidence: 99%

“…Surgical risk was calculated using the logistic EuroSCORE and the Society of Thoracic Surgeons (STS) score (18,19). Demographic, clinical, echocardiographic and hemodynamic variables prior to TAVR were collected as previously reported (13)(14)(15). The study cohort complies with the Declaration of Helsinki and was approved by the local Ethics Committees, and all patients provided informed written consent before the procedure.…”

Section: Study Populationmentioning

confidence: 99%

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Long-term outcomes and prosthesis performance after transcatheter aortic valve replacement: results of self-expandable and balloon-expandable transcatheter heart valves

Tarantini

Purita

D’Onofrio

et al. 2017

Ann. Cardiothorac. Surg.

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Background: Data on transcatheter aortic valve replacement (TAVR) long-term clinical outcomes and hemodynamic performance of the self-expandable CoreValve (CV) and the balloon-expandable Edwards SAPIEN XT (ES) (Edwards Lifesciences, Irvine, California, USA) transcatheter heart valves (THV) are limited. Therefore, this study aimed to compare long-term clinical outcome data and hemodynamic performance of TAVR with either CV or ES. Results: Out of 171 patients treated with TAVR at our Institution, 87 received a CV and 84 an ES THV.Mean age was 81 [78][79][80][81][82][83][84][85] years, and mean Society of Thoracic Surgeons (STS) score was 7.5% (4.5-13.9%).Hemodynamic success by Valve Academic Research Consortium (VARC) definition was 97.1%. Mean trans-prosthetic gradient remained low and stable during follow-up in both groups (at 5-year 9.2±6.4 versus 12.7±5.1 mmHg, P=0.10). Late prosthesis failure occurred in 4 cases (2.4%). Thirty-day mortality was 4.7%, and estimated survival rates by Kaplan-Meyer after 1, 5 and 8 years were 87.6%, 44.9%, and 24.5%, respectively, without difference between THV groups. Rates of cardiovascular death, stroke, myocardial infarction (MI) and congestive heart failure (CHF) were also similar with CV and ES at long-term followup. History of CHF, pre-existent severe mitral regurgitation, paravalvular leak grade ≥2+, and chronic obstructive pulmonary disease were independent predictors of late mortality at multivariable analysis.Conclusions: Clinical and hemodynamic outcomes of patients treated by self-expandable CV or balloonexpandable ES THV were favorable and similar throughout long-term follow-up, with a rate of prosthesis failure of less than 3%.

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Section: Study Populationmentioning

confidence: 99%

Section: Study Populationmentioning

confidence: 99%

Long-term outcomes and prosthesis performance after transcatheter aortic valve replacement: results of self-expandable and balloon-expandable transcatheter heart valves

Tarantini

Purita

D’Onofrio

et al. 2017

Ann. Cardiothorac. Surg.

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“…Although coronary artery disease is present in 34-75% of patients qualified to TAVI, its impact on long-term mortality has not been proven [5,6,8,64,65]. Also, available registry data do not demonstrate short-and long-term benefit of percutaneous coronary intervention (PCI) performed before TAVI [66][67][68][69][70]. These observations may result from variable criteria used for the definition of significant coronary lesions and problems with accurate assessment of fractional flow reserve and the instantaneous wave-free ratio in patients with a significant aortic valve disease [71].…”

Section: Patient Screening and Qualification To Tavimentioning

confidence: 99%

Transcatheter aortic valve implantation. Expert Consensus of the Association of Cardiovascular Interventions of the Polish Cardiac Society and the Polish Society of Cardio-Thoracic Surgeons, approved by the Board of the Polish Cardiac Society…

et al. 2017

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“…While coronary artery bypass grafting is routinely carried out for significant coronary artery disease in the setting of SAVR, the benefit of this approach in the setting of TAVI is currently unclear. 19 Current ongoing trials will provide evidence concerning the best treatment strategy in this patient group.…”

Section: Coronary Angiographymentioning

confidence: 99%

Transcatheter aortic valve implantation – what the general physician needs to know

Ruparelia

Prendergast

2015

Clinical Medicine

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with a 5-10% risk of major adverse perioperative events and a mortality of up to 20% at one year. 5 Given this prohibitively high surgical risk, these patients have historically refused or been denied surgery with no alternative treatment option.Following the first successful human implantation in 2002, 6 transcatheter aortic valve implantation (TAVI) has rapidly developed over the past few years and is now the established treatment option for inoperable or high-risk surgical patients with severe symptomatic AS. 7 In this article, we will summarise the current evidence base and discuss factors that need to be taken into account by the general physician when considering TAVI as a treatment option, including practical aspects and future directions. Current evidenceFollowing the first successful TAVI in 2002, 6 the feasibility, efficacy and safety of the procedure were subsequently confirmed in a number of single-and multi-centre registries. 8 The Placement of AoRTic TraNscathetER Valves (PARTNER) trials were the first prospective randomised studies to compare outcomes of TAVI using the balloon-expandable (BE) Edwards Sapien valve (Edwards LifeSciences, Irvine, CA, USA) with medical management in inoperable patients 9 (cohort B) and with SAVR in patients of high surgical risk (cohort A). 10 When compared with medical therapy (plus balloon aortic valvuloplasty as required), TAVI resulted in a significant reduction in one-year mortality (30.7 vs 50.1%) that was maintained at three-year follow-up (54.1 vs 80.9%). 11 When TAVI was compared with SAVR in high-risk individuals, all-cause mortality was slightly lower with TAVI at 30 days (3.4 vs 6.5%, p=0.07) but comparable three years following implantation (44.2 vs 44%) with long-term symptomatic improvement sustained in both groups. 12 Of late, results of two more contemporary TAVI trials were reported. The non-randomised CoreValve US extremerisk pivotal trial described outcomes of TAVI using the self-expandable (SE) Medtronic CoreValve (Medtronic Inc., Minneapolis, MN, USA) in inoperable patients and demonstrated the efficacy of this treatment option with a 40% reduction in the one-year combined endpoint of all-cause mortality and stroke. 13 The randomised CoreValve US high-risk pivotal trial compared the same device with SAVR in patients deemed to be of high surgical risk. For the first time, TAVI was shown to be associated with a mortality benefit (14.2 vs 19.1%; p<0.0001 for non-inferiority and p=0.04 for superiority).With an increasingly elderly population, the incidence of aortic stenosis (AS) is rising. While surgical aortic valve replacement remains the gold standard treatment for patients with severe symptomatic AS, transcatheter aortic valve implantation (TAVI) has emerged as the treatment of choice for patients who are inoperable or high surgical risk. TAVI has been shown to be associated with a clear mortality benefit when compared with medical therapy and to be at least as good as surgical aortic valve replacement in this patient group. The last few years h...

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

Cited by 90 publications

References 19 publications

Long-term outcomes and prosthesis performance after transcatheter aortic valve replacement: results of self-expandable and balloon-expandable transcatheter heart valves

Long-term outcomes and prosthesis performance after transcatheter aortic valve replacement: results of self-expandable and balloon-expandable transcatheter heart valves

Transcatheter aortic valve implantation. Expert Consensus of the Association of Cardiovascular Interventions of the Polish Cardiac Society and the Polish Society of Cardio-Thoracic Surgeons, approved by the Board of the Polish Cardiac Society…

Transcatheter aortic valve implantation – what the general physician needs to know

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