Transcatheter aortic valve implantation combined with elective coronary artery stenting: a simultaneous approach†

Abstract

Single-stage combined treatment of severe aortic stenosis and highly relevant coronary lesions is a safe and feasible procedure. Early survival and survival up to 3 years are comparable to that observed in patients presenting without CAD who received TAVI only. PCI effectively reduces the complexity of coronary lesions. Although more contrast agent is applied during the combined treatment, the rate of acute kidney injury was not higher.

Management of Coronary Artery Disease in Patients with Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation

“…Patients with AS and coexisting CAD have been reported to be more frequently males, with higher prevalence of peripheral artery disease, previous myocardial infarction, previous PCI, previous CABG, and higher surgical risk. [11][12][13] The clinical characteristics of our patients are consistent with previous reports.…”

“…11,13,17,18) In these studies, the short-term and longterm outcomes of the combined therapy were comparable to those of isolated TAVI. Our results are similar to these previous studies.…”

Functional Assessment of Coronary Artery Disease in Patients Undergoing Transcatheter Aortic Valve Implantation

“…Early and 3-year survival was comparable with that observed in patients without CAD who received TAVI only. 25 Conversely, others analyzed the clinical outcome of 411 TAVIs, 16% of which had significant CAD and received PCI. Incidence of myocardial infarction and 30-day mortality were much higher in the TAVI+PCI group compared with the TAVI alone group (P=0.01).…”

Expanding TAVI options: elective rotational atherectomy during trans-catheter aortic valve implantation

“…In fact, among cases with confirmed significant CAD, those with high SYNTAX score had an increased risk of cardiovascular mortality, stroke, and myocardial infarction at 1 year follow-up compared to those with low SYNTAX score or no CAD (no CAD: 13%, low SYNTAX score: 16%, high SYNTAX score: 30%; p = 0.02) [3]. Unlike coronary artery bypass grafting (CABG) at the time of SAVR, PCI among patients undergoing TAVI appears to confer no excess short-term risk of death, myocardial infarction, and stroke compared with isolated TAVI [2,4,5] although there is no agreement about the real need for treating coronary stenosis before, or after TAVI in the absence of clear signs of ischemia. Such indication may be better addressed by assessing the clinical need dictated by symptoms during follow-up.…”

“…Significant coronary artery disease (CAD) has been reported in more than 60% of octogenarians undergoing surgical aortic valve replacement (SAVR) and in 40 to 75% of high-risk patients undergoing trans-catheter aortic valve implantation (TAVI) [1,2]. The impact of CAD on prognosis among patients undergoing TAVI depends on the angiographic complexity as quantified by the SYNTAX score [3].…”