• Catheter Cardiovasc Interv · Mar 2014

    Comparative Study

    Comparison of early and late outcomes of TAVI alone compared to TAVI plus PCI in aortic stenosis patients with and without coronary artery disease.

    • Yigal Abramowitz, Shmuel Banai, Guy Katz, Arie Steinvil, Yaron Arbel, Ofer Havakuk, Amir Halkin, Yanai Ben-Gal, Gad Keren, and Ariel Finkelstein.
    • Department of Cardiology, The Tel-Aviv Medical Center, Tel-Aviv, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
    • Catheter Cardiovasc Interv. 2014 Mar 1; 83 (4): 649-54.

    ObjectivesTo assess the safety and effectiveness of performing percutaneous coronary intervention (PCI) before transcatheter aortic valve implantation (TAVI).BackgroundThe presence of coronary artery disease (CAD) negatively impact procedural outcomes and long-term survival after (TAVI). The management of obstructive CAD before TAVI is not yet well established.MethodsPatients with severe symptomatic aortic stenosis (AS) (n = 249) that underwent TAVI were divided into two groups: patients with CAD (subdivided to patients treated with TAVI alone and to patients that underwent PCI before TAVI) and patients with isolated AS. Procedural endpoints, device success and adverse events were considered according to the Valve Academic Research Consortium (VARC) definitions.ResultsOf a cohort of 249 consecutive patients with mean age of 83.2 ± 5.5 years, 83 patients with AS + CAD were treated with TAVI alone, 61 patients with AS + CAD underwent PCI before TAVI and 105 patients underwent TAVI for isolated AS. The mean duration of follow-up was 17 months (range: 6-36 months). Despite a significantly higher logistic EuroScore of the AS+CAD group compared to the AS alone group (30.1 vs. 21.1 P < 0. 001), the overall VARC-adjudicated endpoints did not differ between the groups. All-cause mortality at 30-days was 1.6% for patients with AS+CAD treated with PCI compared to 2.9% for patients with AS alone (P = 1).ConclusionsPerforming PCI before TAVI in high-risk elderly patients with significant CAD and severe AS is feasible and safe. This combined treatment approach did not increase the periprocedural risk for complications or the all-cause mortality.Copyright © 2013 Wiley Periodicals, Inc.

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