The safety of concomitant transcatheter aortic valve replacement and percutaneous coronary intervention

Abstract

Background:TAVR is a rapidly spreading treatment option for severe aortic valve stenosis. Significant coronary artery disease (CAD) is present in 40% to 75% of patients undergoing TAVR. However, when to treat the concomitant coronary artery lesions is controversial.Methods:This is a systematic review comparing concomitant PCI and TAVR versus staged PCI and TAVR. The OVID database was systematically searched for studies reporting PCI in patients undergoing TAVR. A random effects model was used to calculate the pooled odds ratio (OR) with 95% confidence intervals.Results:Four observational studies and a total of 209 patients were included in this analysis. Overall 30-day mortality was similar between concomitant PCI and TAVR versus staged PCI and TAVR [OR: 1.47 (0.47–4.62); P = .51], renal failure was not significantly different between both groups [OR: 3.22 (0.61–17.12); P = .17], periprocedural myocardial infarction was not different between the 2 groups [OR: 1.44 (0.12–16.94); P = .77], life-threatening bleeding did not differ between both groups [OR: 0.45 (0.11–1.87); P = .27], and major stroke also was not significantly different [OR: 3.41 (0.16–74.2); P = .44].Conclusion:These data did not show a significant difference in short-term outcomes between concomitant PCI and TAVR versus staged PCI and TAVR.

Coronary revascularization during treatment of severe aortic stenosis: A meta‐analysis of the complete percutaneous approach (PCI plus TAVR) versus the complete surgical approach (CABG plus SAVR)

“…Some recent meta‐analysis of observational studies revealed no difference in short‐term safety outcomes using either staged PCI and TAVR or synchronous PCI and TAVR procedure, however, as the authors mentioned, the results are subject to various confounding factors 26 …”

Aortic Valve Disease and Associated Complex CAD: The Interventional Approach

“…A recent meta-analysis, based on observational data comparing the short-term safety outcomes of concomitant versus staged PCI with TAVI in severe AS patients, demonstrated that the 30-day all-cause mortality and other major safety endpoints did not significantly differ between the two approaches [ 113 ]. Notably, the pooled rate of renal failure was not statistically different between the two groups, although the incidence was relatively higher in the concomitant PCI and TAVI group (5% versus 2.2%) [ 113 ]. Another disadvantage of combining two procedure in the same session is the increased of the procedural complexity as well as the operator fatigue.…”

Transcatheter aortic valve implantation combined with other heart interventions: current status and future perspectives

“…Simultaneous procedures have the advantage of decreasing repeated puncture or incision of vessels, reducing patients' suffering and length of hospital stay, and saving medical resources [11] . However, radiation exposure and the amount of contrast used are usually higher [12] .…”

“…PCI before TAVI, on the other hand, has the potential to minimize ischemic risk during TAVI, particularly during rapid ventricular pacing, and to overcome difficulties associated with coronary access post-TAVI. Conversely, the patient remains at risk for valvular decompensation and needs to be put on dual antiplatelet therapy, which may increase the risk of bleeding during TAVI [11][12][13] . PCI after TAVI is relatively rare because prosthetic valve commissures, or stent frame, may be positioned close to coronary ostia, interfering with coronary diagnostic or guiding catheters [14] .…”

“…Regarding scientific evidence supporting simultaneous or staged procedures, a systematic review of 4 studies, comprising 209 patients, showed no difference in 30-day mortality (OR = 1.47, 95%CI: 0.47-4.62), renal failure (OR = 3.22, 95%CI: 0.61-17.12), periprocedural myocardial infarction (OR = 1.44, 95%CI: 0.12-16.94), life-threatening bleeding (OR = 0.45, 95%CI: 0.11-1.87), and major stroke (OR = 3.41; 95%CI: 0.16-74.2) when PCI was performed concomitant or staged with TAVI [11] .…”