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.
Similar content being viewed by others
References
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
Mohler ER (2000) Are atherosclerotic processes involved in aortic-valve calcification? Lancet 356:524–525
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
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
Gulbins H, Malkoc A, Ennker J (2008) Combined cardiac surgical procedures in octogenarians: operative outcome. Clin Res Cardiol 97:176–180
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
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
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
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
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 > 70 years of age with aortic valvuloplasty, percutaneous coronary intervention versus aortic valvuloplasty alone. Am J Cardiol 101:1309–1314
Conradi L, Reichenspurner H (2008) Review on balloon aortic valvuloplasty: a surgeon’s perspective in 2008. Clin Res Cardiol 97:285–287
Webb JG (2009) Strategies in the management of coronary artery disease, transcatheter aortic valve implantation. Catheter Cardiovasc Interv 73:68
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
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
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
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
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
Conflict of interest
None declared.
Author information
Authors and Affiliations
Corresponding author
Additional information
L. Conradi and M. Seiffert contributed equally to this work.
Rights and permissions
About this article
Cite this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00392-010-0243-6