TCT-652 Outcomes in Patients with Transcatheter Aortic Valve Replacement and Left Main Stent: The multicenter, multinational TAVR-LM Registry

Chakravarty, Tarun; Sharma, Rahul; Abramowitz, Yigal; Kapadia, Samir; Latib, Azeem; Jilaihawi, Hasan; Poddar, Kanhaiya L.; Giustino, Gennaro; Ribeiro, Henrique Barbosa; Tchétché, Didier; Monteil, Benoît; Testa, Luca; Tarantini, Giuseppe; Facchin, Michela; Lefèvre, Thierry; Lindman, Brian R.; Hariri, Babak; Patel, J.; Takahashi, Nobuyuki; Matar, George; Mirocha, James; Cheng, Wen; Tuzcu, E. Murat; Sievert, Horst; Rodés‐Cabau, Josep; Colombo, Antonio; Finkelstein, Ariel; Fajadet, Jean; Makkar, Raj

doi:10.1016/j.jacc.2015.08.671

Cited by 19 publications

(29 citation statements)

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“…The latter indication may be of particular importance given our finding that patients with IR Major are at an increased risk of AMI or revascularization after valve implantation. The safety of PCI in patients with untreated severe AS has previously been shown, even in patients with unprotected left main disease . However, special consideration should be taken in patients with highly calcified atherosclerosis requiring atherectomy, given the anticipated long ischemic time and drastic hemodynamic compromise associated with atherectomy.…”

Section: Discussionmentioning

confidence: 99%

Impact of residual coronary atherosclerosis on transfemoral transcatheter aortic valve replacement

Patel

Nadeem

et al. 2018

Cathet Cardio Intervent

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Objectives This study reports on the clinical effects of complete vs incompletely revascularized coronary artery disease on transcatheter aortic valve replacement (TAVR). Background There is a high prevalence of active coronary artery disease (CAD) in patients undergoing TAVR but preemptive revascularization remains controversial. Methods Patients were categorized into three cohorts: complete revascularization (CR), incomplete revascularization of a major epicardial artery (IR Major), and incomplete revascularization of a minor epicardial artery only (IR Minor). When feasible, SYNTAX scoring was performed for exploratory analysis. Analyses were performed using Cox proportional hazard models and Kaplan–Meier method. Results A total of 323 patients with active CAD were included. Adjusted outcomes showed that patients with IR Major had increased incidence of acute myocardial infarction (AMI) or revascularization compared with those in the CR cohort (HR 3.72, P = 0.048). No difference was noted in all‐cause mortality or all‐cause readmission rates. Exploratory secondary analysis with residual SYNTAX scores showed a significant interaction between disease burden and AMI/revascularization, as well as all‐cause readmission. All‐cause mortality remained unaffected based on residual SYNTAX scores. Conclusions This is a retrospective single‐center study reporting on pre‐TAVR revascularization outcomes in patients with active CAD. In this analysis, we found that patients undergoing TAVR benefited from achieving complete revascularization to abate future incidence of AMI/revascularization. Despite this finding, all‐cause mortality remained unaffected. Future efforts should focus on the role of functional assessment of the coronaries, as well as the long‐term effects of complete revascularization in a larger patient cohort.

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Section: Discussionmentioning

confidence: 99%

Impact of residual coronary atherosclerosis on transfemoral transcatheter aortic valve replacement

Patel

Nadeem

et al. 2018

Cathet Cardio Intervent

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“…Large registry data have confirmed the safety of PCI (including LM disease) in the setting of severe AS, but does not address patients with severe LV dysfunction . In a study by Goel et al, patients with severe symptomatic AS who had LVEF <30% had a much higher post‐PCI mortality than patients with preserved LVEF (hazard ratio 2.83, confidence interval 1.79‐4.49, p < 0.001) .…”

Section: Discussionmentioning

confidence: 99%

“…Significant coronary artery disease (CAD) is present in 40% to 75% of patients with severe AS undergoing TAVR . Currently, there are no guidelines with regards to percutaneous coronary intervention (PCI) in these patients . Between 25% and 32% of patients with severe AS undergoing TAVR have reduced left ventricular (LV) ejection fraction (LVEF; <50%), of whom one third have severe LV dysfunction (LVEF <30%) .…”

Section: Introductionmentioning

confidence: 99%

Mechanical circulatory support in patients with severe aortic stenosis and left ventricular dysfunction undergoing percutaneous coronary intervention

Alkhouli

Mustafa²,

Chaker³

et al. 2017

J Card Surg

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Management of obstructive coronary artery disease in patients with aortic stenosis and severe left ventricular dysfunction is challenging. Mechanical circulatory support at the time of percutaneous coronary interventions may be necessary in these extreme-risk patients. We present a case in which the TandemHeart was used to support a patient with severe aortic stenosis, severe protected left main and circumflex disease, and severe cardiomyopathy and review the literature on this subject.

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“…The same-setting or concomitant approach is also favoured for ostial lesions with high-risk features for coronary obstruction, as coronary protection strategies with a guidewire can be adopted (12). This strategy might also be beneficial as it minimises pre-procedural dualantiplatelet therapy exposure and thus bleeding risks.…”

Section: Timing Of Revascularizationmentioning

confidence: 99%

Revascularizing coronary artery disease in patients undergoing transcatheter aortic valve implantation

2018

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Coronary artery disease (CAD) is common among p a t i e n t s u n d e r g o i n g t r a n s c a t h e t e r a o r t i c v a l v e implantation (TAVI) with a prevalence of up to 75%, and no clear recommendations around its treatment (1) and conflicting evidence around whether to perform coronary revascularization or not. Moreover, the role of revascularization on long-term morbidity and mortality is still not clear in octogenarians (2). Piccolo and colleagues (3) have provided an interesting editorial comment on our work (1), and further pointed out controversies with regards to revascularization of patients with CAD and undergoing TAVI.The authors also commented on their own results (4), based on an elegant age-and gender-matched analysis where they found a significant increase in the composite of cardiovascular death, myocardial infarction, or stroke at 1-year among TAVI patients with CAD. However, it should be highlighted that the authors found a similar risk of ischemic events during TAVI procedures among patients without CAD as compared to the matched population with CAD. Even when the complexity and severity of CAD is considered and the SYNTAX score is used to stratify CAD severity, the evidence is mixed with regards to mortality outcomes (5,6). Moreover, emerging data on completeness of revascularization is also conflicting. Indeed, while Van Mieghem and colleagues (7) suggested no influence of completeness of revascularization on mortality, a recent large analysis showed that incompleteness of revascularization and more severe CAD were independent predictors of mortality (6).Our findings indicate no benefit in 30-day and 1-year outcomes with a revascularization strategy. Notably, revascularized patients were at higher-risk of major vascular complications, although data were derived from percutaneous coronary intervention (PCI) undertaken through the transfemoral approach and much of the data analysed was subject to the inherent limitations of observational registries such as selection biases and unmeasured confounding. Revascularization strategiesIn terms of symptoms assessment, it is often difficult to rely upon them in this population and tools conventionally used in patients with stable angina to guide revascularization (i.e., fractional flow reserve) are still not well validated and widely used in the setting of severe aortic stenosis. Hence, it is reasonable to percutaneously revascularize ostial or

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TCT-652 Outcomes in Patients with Transcatheter Aortic Valve Replacement and Left Main Stent: The multicenter, multinational TAVR-LM Registry

Cited by 19 publications

References 0 publications

Impact of residual coronary atherosclerosis on transfemoral transcatheter aortic valve replacement

Impact of residual coronary atherosclerosis on transfemoral transcatheter aortic valve replacement

Mechanical circulatory support in patients with severe aortic stenosis and left ventricular dysfunction undergoing percutaneous coronary intervention

Revascularizing coronary artery disease in patients undergoing transcatheter aortic valve implantation

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