Timing and Outcomes of Percutaneous Coronary Intervention in Patients Who Underwent Transcatheter Aortic Valve Implantation

Aim The aim of this study was to investigate the pattern, causes and predictors of all new hospitalizations in patients who underwent TAVI. Methods and results The nationwide Swedish TAVI-registry was merged with other mandatory health care registries, which enabled the analysis of all TAVI-procedures, new hospital admissions and death between the years 2008 and 2017. A total of 2821 patients underwent TAVI with a mean of 2.5 hospitalizations during a mean Follow-up of 2.2 years. Hospitalizations were associated with worse prognosis. Heart failure (HF) was the most common cause of hospitalization with 19% having at least one hospitalization due to HF causing 16% of all-cause admissions and 50% of cardiovascular admissions. Male gender, age > 90 years, high Charlson Comorbidity Index, atrial fibrillation, present neurologic disease, severe renal impairment, peripheral vascular disease, New York Heart Association class IV, mild or moderate mean aortic valve gradients and pulmonary hypertension were associated with an increased risk for all-cause hospitalizations or death. For cardiovascular hospitalization or death, the pattern was similar, with the addition of impaired systolic left ventricular function as a predictor. Conclusion Multiple hospitalizations after TAVI are common, and are often caused by HF. Reducing the rate of HF hospitalizations is important to mitigate the burden on the health care system due to new hospitalizations after TAVI.

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“…The relatively high frequency highlights the question of timing of revascularization, an area where further research is needed. 25 …”

Section: Discussionmentioning

confidence: 99%

Causes, pattern, predictors, and prognostic implications of new hospitalizations after transcatheter aortic valve implantation: a long-term nationwide observational study

Nilsson

Buccheri

Christersson

et al. 2021

European Heart Journal - Quality of Care and Clinical Outcomes

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“…The potential advantages of this approach are: (i)No requirement for additional vascular access, (ii) lower theoretical risk of vascular complications, (iii) lower patient's inconvenience and discomfort and iv) reduction in healthcare resources utilization. Ochiai et al found that the timing of PCI either before TAVI (n = 143), concomitantly with TAVI (n = 77), or until after TAVI (n = 38) was not associated with 2-year major adverse cardiac and cerebrovascular events rate (concomitant vs. pre-TAVI, HR: 0.92; 95% CI: 0.52 to 1.66; p = 0.79; post-vs. pre-TAVI, HR: 0.45; 95% CI: 0.18 to 1.16; p = 0.10) [110]. Wenaweser et al showed that the clinical outcome at 30 days was similar for patients undergoing isolated TAVI as compared with TAVI combined with PCI in terms of death (5.6% vs. 10.2%, p = 0.24), major stroke (4.1% vs. 3.4%, p = 1.00), and the VARC combined safety endpoint (31.0% vs. 23.7%, p = 0.33) [111].…”

Section: Pci and Concomitant Tavimentioning

confidence: 96%

Aortic Valve Disease and Associated Complex CAD: The Interventional Approach

Marin

Scarsini

Kotronias

et al. 2021

JCM

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Coronary artery disease (CAD) is highly prevalent in patients with severe aortic stenosis (AS). The management of CAD is a central aspect of the work-up of patients undergoing transcatheter aortic valve implantation (TAVI), but few data are available on this field and the best percutaneous coronary intervention (PCI) practice is yet to be determined. A major challenge is the ability to elucidate the severity of bystander coronary stenosis independently of the severity of aortic valve stenosis and subsequent impact on blood flow. The prognostic role of CAD in patients undergoing TAVI is being still debated and the benefits and the best timing of PCI in this context are currently under evaluation. Additionally, PCI in the setting of advanced AS poses some technical challenges, due to the complex anatomy, risk of hemodynamic instability, and the increased risk of bleeding complications. This review aims to provide a comprehensive synthesis of the available literature on myocardial revascularization in patients with severe AS undergoing TAVI. This work can assist the Heart Team in individualizing decisions about myocardial revascularization, taking into account available diagnostic tools as well as the risks and benefits.

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“…[ 6 ] Ochiai et al investigated the optimal timing for PCI comparing three strategies (PCI pre-TAVI versus PCI concomitant to TAVI versus PCI post-TAVI) and found no differences after 2-year follow-up in the composite of major adverse cardiac and cerebrovascular events (concomitant versus pre-TAVI, HR 0.92; 95% CI [0.52–1.66]; p=0.79; post- versus pre-TAVI, HR 0.45; 95% CI [0.18– 1.16]; p=0.10). [ 52 ] Therefore, the optimal timing of PCI and TAVI remains unclear and must be individualised for each patient ( Table 3 ).…”

Section: Intervention In Tavi Patientsmentioning

confidence: 99%

“…Optimising transcatheter aortic valve commissural alignment in native annulus may avoid coronary artery overlap and facilitate coronary access in the future, especially using certain types of self-expandable transcatheter bioprostheses (Evolut from Medtronic and ACURATE-neo from Boston Scientific). [ 52 – 56 ] Redondo et al developed a promising method for proper commissural alignment (ACURATE-neo bioprosthesis) to insert the delivery system with a patient-specific rotation based on CT data analysis, tested in 3D, printed in silico models and in vivo. [ 56 ] The results suggested an important reduction in commissural misalignment and coronary artery overlap.…”

Section: Intervention In Tavi Patientsmentioning

confidence: 99%

Coronary Artery Disease in Patients with Aortic Stenosis and Transcatheter Aortic Valve Implantation: Implications for Management

Filho¹,

Accorsi

Ribeiro

2021

Eur Cardiol

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Aortic valve stenosis (AS) is the most common valvular heart disease among elderly patients. Since the pathophysiology of degenerative AS shares common pathways with atherosclerotic disease, the severity of AS in the elderly population is often concurrent to the presence of coronary artery disease (CAD). Although surgical aortic valve replacement has been the standard treatment for severe AS, the high operative morbidity and mortality in complex and fragile patients was the trigger to develop less invasive techniques. Transcatheter aortic valve implantation (TAVI) has been posed as the standard of care for elderly patients with severe AS with various risk profiles, which has meant that the concomitant management of CAD has become a crucial issue in such patients. Given the lack of randomised controlled trials evaluating the management of CAD in TAVI patients, most of the recommendations are based on retrospective cohort studies so that the Heart Team approach – together with an assessment of multiple parameters including symptoms and clinical characteristics, invasive and non-invasive ischaemic burden and anatomy – are crucial for the proper management of these patients. This article provides a review of current knowledge about assessment and therapeutic approaches for CAD and severe AS in patients undergoing TAVI.

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Timing and Outcomes of Percutaneous Coronary Intervention in Patients Who Underwent Transcatheter Aortic Valve Implantation

Cited by 31 publications

References 16 publications

Causes, pattern, predictors, and prognostic implications of new hospitalizations after transcatheter aortic valve implantation: a long-term nationwide observational study

Causes, pattern, predictors, and prognostic implications of new hospitalizations after transcatheter aortic valve implantation: a long-term nationwide observational study

Aortic Valve Disease and Associated Complex CAD: The Interventional Approach

Coronary Artery Disease in Patients with Aortic Stenosis and Transcatheter Aortic Valve Implantation: Implications for Management

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