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First experience with transcatheter aortic valve implantation and concomitant percutaneous coronary intervention

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Abstract

Objectives

We investigated our experience with combined transcatheter aortic valve implantation (TAVI) and percutaneous coronary intervention (PCI) as an alternative strategy in high-risk patients.

Background

Combined surgical aortic valve replacement and coronary artery bypass grafting are the gold standard treatment for patients with aortic stenosis and concomitant coronary artery disease. However, a substantial share of patients is unfit for surgery due to contraindications.

Methods

Twenty-eight patients (15 female) underwent combined TAVI and PCI after being refused for surgery. In 21 patients (group 1) a staged approach of PCI prior to subsequent TAVI was chosen. Seven patients (group 2) were treated in a single-stage procedure.

Results

Mean patient age was 80.1 ± 6.9 years, pre-procedural risk assessment revealed a mean logEuroSCORE of 26.8 ± 13.4%. Left ventricular ejection fraction was 45.6 ± 11.1%. Baseline mean/peak transvalvular gradients were 40.2 ± 16.8 and 65.6 ± 26.6 mmHg, respectively, and decreased to mean/peak values of 9.3 ± 4.2/15.2 ± 8.4 mmHg (p < 0.0001), effective orifice area increased from 0.73 ± 0.25 to 1.74 ± 0.47 cm2 (p < 0.0001). In group 2, fluoroscopy time and amount of contrast agent were significantly higher compared to group 1 (18.1 ± 9.2 vs. 9.5 ± 7.0 min; p = 0.03/292.3 ± 117.5 vs. 171.9 ± 68.4 ml; p = 0.006). In group 1, patients received PCI 14.3 ± 9.6 days prior to TAVI. In group 2, PCI was performed immediately before TAVI. A mean of 1.6 ± 1.0 stents was placed per patient. No periprocedural myocardial infarction or stroke occurred in any patient. Thirty-day mortality was 7.1% (2/28).

Conclusion

Our strategy of staged or single-stage TAVI and PCI proved feasible and safe in this high-risk patient population. Whether there is advantage of one approach over the other remains to be elucidated.

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References

  1. Otto CM, Lind BK, Kitzman DW, Gersh BJ, Siscovick DS (1999) Association of aortic valve sclerosis with cardiovascular mortality and morbidity in the elderly. N Engl J Med 341:142–147

    Article  PubMed  CAS  Google Scholar 

  2. Mohler ER (2000) Are atherosclerotic processes involved in aortic-valve calcification? Lancet 356:524–525

    Article  PubMed  Google Scholar 

  3. Stewart BF, Siscovick D, Lind BK, Gardin JM, Gottdiener JS, Smith VE, Kitzman DW, Otto CM (1997) Clinical factors associated with calcific aortic valve disease. Cardiovascular Health Study. J Am Coll Cardiol 29:630–634

    Article  PubMed  CAS  Google Scholar 

  4. Bonow RO, Carabello BA, Chatterjee K, de Leon AC Jr, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O′Gara PT, O′Rourke RA, Otto CM, Shah PM, Shanewise JS, 2006 Writing Committee Members, American College of Cardiology/American Heart Association Task Force (2008) 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the american college of cardiology/american heart association task force on practice guidelines (writing committee to revise the 1998 guidelines for the management of patients with valvular heart disease): endorsed by the society of cardiovascular anesthesiologists, society for cardiovascular angiography and interventions, and society of thoracic surgeons. Circulation 118:e523–e661

    Article  PubMed  Google Scholar 

  5. Gulbins H, Malkoc A, Ennker J (2008) Combined cardiac surgical procedures in octogenarians: operative outcome. Clin Res Cardiol 97:176–180

    Article  PubMed  CAS  Google Scholar 

  6. Kolh P, Kerzmann A, Honore C, Comte L, Limet R (2007) Aortic valve surgery in octogenarians: predictive factors for operative, long-term results. Eur J Cardiothorac Surg 31:600–606

    Article  PubMed  Google Scholar 

  7. Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Bärwolf C, Levang OW, Tornos P, Vanoverschelde JL, Vermeer F, Boersma E, Ravaud P, Vahanian A (2003) A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on Valvular Heart Disease. Eur Heart J 24:1231–1243

    Article  PubMed  Google Scholar 

  8. Walther T, Simon P, Dewey T, Wimmer-Greinecker G, Falk V, Kasimir MT, Doss M, Borger MA, Schuler G, Glogar D, Fehske W, Wolner E, Mohr FW, Mack M (2007) Transapical minimally invasive aortic valve implantation: multicenter experience. Circulation 116:I240–I245

    Article  PubMed  Google Scholar 

  9. Brinster DR, Byrne M, Rogers CD, Baim DS, Simon DI, Couper GS, Cohn LH (2006) Effectiveness of same day percutaneous coronary intervention followed by minimally invasive aortic valve replacement for aortic stenosis, moderate coronary disease (“hybrid approach”). Am J Cardiol 98:1501–1503

    Article  PubMed  Google Scholar 

  10. Pedersen WR, Klaassen PJ, Pedersen CW, Wilson JA, Harris KM, Goldenberg IF, Poulose AK, Mooney MR, Henry TD, Schwartz RS (2008) Comparison of outcomes in high-risk patients &gt; 70 years of age with aortic valvuloplasty, percutaneous coronary intervention versus aortic valvuloplasty alone. Am J Cardiol 101:1309–1314

    Article  PubMed  Google Scholar 

  11. Conradi L, Reichenspurner H (2008) Review on balloon aortic valvuloplasty: a surgeon’s perspective in 2008. Clin Res Cardiol 97:285–287

    Article  PubMed  Google Scholar 

  12. Webb JG (2009) Strategies in the management of coronary artery disease, transcatheter aortic valve implantation. Catheter Cardiovasc Interv 73:68

    Article  PubMed  Google Scholar 

  13. Berry C, Lamarche Y, Laborde JC, Cartier R, Denault AY, Basmadjian A, Bonan R (2006) First case of combined percutaneous aortic valve replacement, coronary artery revascularization. EuroIntervention 2:257–261

    PubMed  Google Scholar 

  14. Piazza N, Serruys PW, de Jaegere P (2009) Feasibility of complex coronary intervention in combination with percutaneous aortic valve implantation in patients with aortic stenosis using percutaneous left ventricular assist device (TandemHeart®). Catheter Cardiovasc Interv 73:161–166

    Article  PubMed  Google Scholar 

  15. Iung B, Drissi MF, Michel PL, de Pamphilis O, Tsezana R, Cormier B, Vahanian A, Acar J (1993) Prognosis of valve replacement for aortic stenosis with or without coexisting coronary heart disease: a comparative study. J Heart Valve Dis S2:430–439

    Google Scholar 

  16. Dewey TM, Brown DL, Herbert MA, Culica D, Smith CR, Leon MB, Svensson LG, Tuzcu M, Webb JG, Cribier A, Mack MJ (2010) Effect of concomitant coronary artery disease on procedural, late outcomes of transcatheter aortic valve implantation. Ann Thorac Surg 89:758–767

    Article  PubMed  Google Scholar 

  17. Masson JB, Lee M, Boone RH, Al Ali A, Al Bugami SA, Hamburger J, Mancini GBJ, Ye J, Cheung A, Humphries KH, Wood D, Nietlispach F, Webb JG (2010) Impact of coronary artery disease on outcomes after transcatheter aortic valve implantation. Catheter Cardiovasc Interv 76:165–173

    Article  PubMed  Google Scholar 

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Correspondence to Lenard Conradi.

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L. Conradi and M. Seiffert contributed equally to this work.

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Conradi, L., Seiffert, M., Franzen, O. et al. First experience with transcatheter aortic valve implantation and concomitant percutaneous coronary intervention. Clin Res Cardiol 100, 311–316 (2011). https://doi.org/10.1007/s00392-010-0243-6

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  • DOI: https://doi.org/10.1007/s00392-010-0243-6

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