Author + information
- Ömer Aktug1,
- Ralf Herpertz1,
- Kathrin Brehmer1,
- Rüdiger Autschbach2,
- Nikolaus Marx1,
- Shahram Lotfi2 and
- Rainer Hoffmann1
Combined surgical aortic valve replacement (SAVR) and coronary artery bypass grafting (CABG) in patients with aortic stenosis (AS) and concomitant coronary artery disease (CAD) is associated with increased operative risks. There is little knowledge on the outcome associated with performing percutaneous coronary intervention (PCI) in combination with transcatheter aortic valve implantation (TAVI).
Aim of Study: To investigate the outcome of combined TAVI and PCI in high-risk patients with symptomatic high-grade AS and significant CAD.
From 1/2008 until 6/2012 338 consecutive patients (79.9±6.0 years, logEuroSCORE 18±11%) successfully treated with Medtronic CoreValve™ (n=183), Edwards-SAPIEN™ (n=146) or Symetis Acurate™ bioprosthesis (n=9) were included in the analysis. 221 patients (66%) had CAD. 66 patients (19.5%, 33 female) with significant CAD underwent combined TAVI and PCI. In 58 patients (group A) a staged approach of PCI a mean of 13±9 days prior to subsequent TAVI was chosen. 8 patients (group B) were treated in a single procedure with PCI first. 272 patients underwent only TAVI (group C).
30 day mortality for patients undergoing TAVI plus PCI was similar to patients with isolated TAVI (12.1% vs. 9.9%; OR=1.4, 95% CI 0.6-3.267; p=0.436). 7 patients (10.6%) of the TAVI plus PCI group had a periprocedural myocardial infarction (NSTEMI) and stroke occurred in two patients (4.7%). There were no significant differences between TAVI plus PCI group vs. TAVI only group with regards to vascular complications and postprocedure acute renal failure. Contrast volume at TAVI implantation was higher in group B compared to group A patients (251±60 vs. 179±73 ml; p=0.022).
CAD is frequent among patients with severe AS undergoing TAVI. Revascularization with PCI can be safely performed in addition to TAVI either as a staged or a concomitant intervention in this high-risk patient population.