Author + information
- Received June 16, 2015
- Revision received October 19, 2015
- Accepted October 20, 2015
- Published online March 1, 2016.
- Tarun Chakravarty, MDa,
- Rahul Sharma, MDa,
- Yigal Abramowitz, MDa,b,
- Samir Kapadia, MDc,
- Azeem Latib, MDd,
- Hasan Jilaihawi, MDa,
- Kanhaiya Lal Poddar, MBBSc,
- Gennaro Giustino, MDd,
- Henrique B. Ribeiro, MDe,
- Didier Tchetche, MDf,
- Benoit Monteil, MDf,
- Luca Testa, MDg,
- Giuseppe Tarantini, MDh,
- Michela Facchin, MDh,
- Thierry Lefèvre, MDi,
- Brian R. Lindman, MDj,
- Babak Hariri, MSa,
- Jigar Patel, MDa,
- Nobuyuki Takahashi, MDa,
- George Matar, BSa,
- James Mirocha, MSa,
- Wen Cheng, MDa,
- Murat E. Tuzcu, MDc,
- Horst Sievert, MDk,
- Josep Rodés-Cabau, MDe,
- Antonio Colombo, MDd,
- Ariel Finkelstein, MDb,
- Jean Fajadet, MDf and
- Raj R. Makkar, MDa,∗ ()
- aCedars-Sinai Heart Institute, Los Angeles, California
- bTel Aviv Medical Center, Tel Aviv, Israel
- cCleveland Clinic, Cleveland, Ohio
- dSan Raffaele Scientific Institute and EMO-GVM Centro Cuore Columbus, Milan, Italy
- eQuebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
- fClinique Pasteur, Toulouse, France
- gIRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
- hDepartment of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
- iHopital Privé Jacques Cartier, Massy, France
- jWashington University School of Medicine, St. Louis, Missouri
- kCardioVascular Center Frankfurt CVC, Frankfurt, Germany
- ↵∗Reprint requests and correspondence:
Dr. Raj R. Makkar, Heart Institute, Cedars-Sinai Medical Center, Cardiovascular Intervention Center, 8631 W. Third Street, #415-E, Los Angeles, California 90048.
Background A percutaneous approach with transcatheter aortic valve replacement (TAVR) and percutaneous coronary intervention (PCI) of the left main coronary artery (LM) is frequently used in high-risk patients with coexisting aortic stenosis and LM disease. Outcomes of TAVR plus LM PCI have not been previously reported.
Objectives The primary objective of the TAVR-LM registry is to evaluate clinical outcomes in patients undergoing TAVR plus LM PCI.
Methods Clinical, echocardiographic, computed tomographic, and angiographic characteristics were retrospectively collected in 204 patients undergoing TAVR plus LM PCI. In total, 128 matched patient pairs were generated by performing 1:1 case-control matching between 167 patients with pre-existing LM stents undergoing TAVR and 1,188 control patients undergoing TAVR without LM revascularization.
Results One-year mortality (9.4% vs. 10.2%, p = 0.83) was similar between the TAVR plus LM PCI cohort and matched controls. One-year mortality after TAVR plus LM PCI was not different in patients with unprotected compared with protected LMs (7.8% vs. 8.1%, p = 0.88), those undergoing LM PCI within 3 months compared with those with LM PCI greater than 3 months before TAVR (7.4% vs. 8.6%, p = 0.61), and those with ostial versus nonostial LM stents (10.3% vs. 15.6%, p = 0.20). Unplanned LM PCI performed because of TAVR-related coronary complication, compared with planned LM PCI performed for pre-existing LM disease, resulted in increased 30-day (15.8% vs. 3.4%, p = 0.013) and 1-year (21.1% vs. 8.0%, p = 0.071) mortality.
Conclusions Despite the anatomic proximity of the aortic annulus to the LM, TAVR plus LM PCI is safe and technically feasible, with short- and intermediate-term clinical outcomes comparable with those in patients undergoing TAVR alone. These results suggest that TAVR plus LM PCI is a reasonable option for patients who are at high risk for surgery.
- aortic valve stenosis
- coronary artery disease
- percutaneous coronary intervention
- transcatheter aortic valve replacement
Dr. Lindman is supported by grant K23 HL116660 from the National Institutes of Health. Dr. Latib has served as a consultant for Medtronic and Direct Flow Medical. Dr. Jilaihawi has served as a consultant for Edwards Lifesciences, St. Jude Medical, and Venus Medtech. Dr. Tarantini has received a lecture fee from Edwards Lifesciences. Dr. Lefèvre was a proctor for Edwards Lifesciences; and has received minor fees from Medtronic and Direct Flow Medical. Dr. Lindman has received research support from and served on the scientific advisory board for Roche Diagnostics. Dr. Tuzcu is an Executive Committee member for the PARTNER trial; and principal investigator of the SALUS trial. Dr. Sievert has received study honoraria, travel expenses, and consulting fees (<$25,000) from Abbott, Access Closure, AGA, Angiomed, Aptus, Atrium, Avinger, Bard, Boston Scientific, Bridgepoint, Cardiac Dimensions, CardioKinetix, CardioMEMS, Coherex, Contego, Covidien, CSI, CVRx, EndoCross, ev3, FlowCardia, Gardia, Gore, Guided Delivery Systems, InSeal Medical, Lumen Biomedical, HLT, Lifetech, Lutonix, Maya Medical, Medtronic, NDC, Occlutech, Osprey, Ostial, PendraCare, pfm Medical, Recor, ResMed, Rox Medical, SentreHEART, Spectranetics, SquareOne, Svelte Medical Systems, Trireme, Trivascular, Venus Medical, Veryan, and Vessix; has received grant research support (<$25,000) from Cook and St. Jude Medical; and has stock options (<$25,000) with Cardiokinetix, Access Closure, Velocimed, Lumen Biomedical, Coherex, and SMT. Dr. Rodés-Cabau has received grant support from Boston Scientific and Edwards Lifesciences; and consulting fees and honoraria from AstraZeneca, Bristol-Myers Squibb, Daiichi-Sankyo/Eli Lilly, GlaxoSmithKline, Janssen, Merck/Schering-Plough, and Regeneron. Dr. Colombo is a minor shareholder in Direct Flow Medical. Dr. Makkar is the principal investigator for the St. Jude Medical Portico trial; has received research grants from Edwards Lifesciences, St. Jude Medical, and Medtronic; and has received a consulting fee from Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
John Bittl, MD, served as Guest Editor for this paper.
- Received June 16, 2015.
- Revision received October 19, 2015.
- Accepted October 20, 2015.
- American College of Cardiology Foundation