Journal of the American College of Cardiology
Original Investigation
Outcomes in Patients With Transcatheter Aortic Valve Replacement and Left Main StentingThe TAVR-LM Registry
Tarun Chakravarty, Rahul Sharma, Yigal Abramowitz, Samir Kapadia, Azeem Latib, Hasan Jilaihawi, Kanhaiya Lal Poddar, Gennaro Giustino, Henrique B. Ribeiro, Didier Tchetche, Benoit Monteil, Luca Testa, Giuseppe Tarantini, Michela Facchin, Thierry Lefèvre, Brian R. Lindman, Babak Hariri, Jigar Patel, Nobuyuki Takahashi, George Matar, James Mirocha, Wen Cheng, Murat E. Tuzcu, Horst Sievert, Josep Rodés-Cabau, Antonio Colombo, Ariel Finkelstein, Jean Fajadet and Raj R. Makkar
Table 5
Table 5
Clinical Outcomes According to Planned and Unplanned Left Main Coronary Artery Percutaneous Coronary Intervention
| Planned LM PCI (n = 176) | Unplanned LM PCI (n = 19) | p Value | |
|---|---|---|---|
| Procedural outcomes | |||
| LM obstruction | 2 (1.1)∗ | 18 (94.7) | <0.01 |
| LM dissection | 0 (0.0) | 1 (5.3) | <0.01 |
| RCA obstruction | 0 (0.0) | 1 (5.3) | <0.01 |
| Need for cardiopulmonary resuscitation | 1 (0.6) | 3 (15.8) | <0.01 |
| Emergent open heart surgery | 0 (0.0) | 0 (0.0) | NA |
| Timing of LM obstruction | 0.93 | ||
| After BAV | 0 (0.0) | 1 (6.3) | |
| After valve implantation | 1 (100.0)∗ | 11 (68.8) | |
| After post-dilation | 0 (0.0) | 2 (12.5) | |
| Within 24 h of TAVR | 0 (0.0) | 2 (12.5) | |
| Intraprocedural death | 0 (0.0) | 0 (0.0) | NA |
| Valve embolization | 1 (0.6) | 0 (0.0) | 0.74 |
| Need for second valve | 8 (4.8) | 1 (5.3) | 0.93 |
| Cardiac tamponade | 0 (0.0) | 0 (0.0) | NA |
| Cardiogenic shock | 6 (3.4) | 4 (21.1) | <0.01 |
| New LBBB | 20 (11.4) | 2 (10.5) | 0.91 |
| Permanent pacemaker | 38 (21.6) | 2 (10.5) | 0.26 |
| Acute renal failure | 10 (5.8) | 5 (26.3) | <0.01 |
| Need for hemodialysis | 6 (3.5) | 2 (11.1) | 0.12 |
| Major vascular complication | 23 (13.1) | 2 (10.5) | 0.75 |
| Major or life-threatening bleeding | 25 (14.2) | 2 (10.5) | 0.66 |
| Duration of hospital stay (days) | 5.5 ± 7.1 | 10.9 ± 10.0 | 0.01 |
| 30-day outcomes | |||
| Mortality | 6 (3.4) | 3 (15.8) | 0.013 |
| Target vessel revascularization | 0 (0.0) | 0 (0.0) | NA |
| Myocardial infarction | 1 (0.6) | 0 (0.0) | 0.74 |
| Stroke | 2 (1.1) | 1 (5.3) | 0.16 |
| 1-yr mortality | |||
| Mortality | 14 (8.0) | 4 (21.1) | 0.07 |
| Target vessel revascularization | 7 (4.0) | 0 (0.0) | 0.40 |
| Myocardial infarction | 4 (2.3) | 0 (0.0) | 0.52 |
| Stroke | 3 (1.7) | 1 (5.3) | 0.29 |
Values are n (%).
BAV = bicuspid aortic valve; LBBB = left bundle branch block; other abbreviations as in Tables 1 and 2.
↵∗ Two patients with pre-existing LM stents undergoing TAVR experienced LM stent impingement by the transcatheter heart valve. This was successfully managed with balloon angioplasty of the LM stent.
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