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. 2012 Apr;14(4):463-8.
doi: 10.1093/icvts/ivr144. Epub 2012 Jan 9.

Combined elective percutaneous coronary intervention and transapical transcatheter aortic valve implantation

Miralem Pasic  1 , Stephan Dreysse, Axel Unbehaun, Semih Buz, Thorsten Drews, Christoph Klein, Giuseppe D'Ancona, Roland Hetzer
Affiliations

Combined elective percutaneous coronary intervention and transapical transcatheter aortic valve implantation

Miralem Pasic et al. Interact Cardiovasc Thorac Surg. 2012 Apr.

Abstract

There is no established strategy of how and when to treat coronary artery disease (CAD) in patients referred for transcatheter aortic valve implantation (TAVI). Simultaneous, single-stage treatment of both pathologies is a possible solution. We report our initial results of simultaneously performed transapical TAVI and elective percutaneous coronary interventions (PCI) in high-risk patients with severe aortic valve stenosis. Between April 2008 and July 2011, a total of 419 patients underwent transapical TAVI. Combined elective PCI and TAVI were performed in 46 (11%) patients. Only the most significant coronary lesion or lesions were treated. Technical success of the combined approach was 100%. The mean count of implanted stents per patient was 1.6 ± 1.0 (range, 1-5 stents). The 30-day mortality rates in the PCI and TAVI group was 4.3%. Survival at 12, 24 and 36 months of the PCI and TAVI group 87.1 ± 5.5, 69.7 ± 10.3 and 69.7 ± 10.3%, respectively. The results showed that the single-stage approach with combined elective PCI and TAVI is feasible and safe. It has become our primary choice for treatment of high-risk patients with severe aortic valve stenosis and CAD.

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Figures

Figure 1:
Figure 1:
Percutaneous coronary intervention of the proximal dominant right coronary artery (a–c). Note the already implanted Edwards Sapien valve.
Figure 2:
Figure 2:
Sequences of combined transapical aortic valve implantation (a–c) and percutaneous coronary intervention (d–f) of the proximal left anterior descending artery (arrow) in a 98-year old male patient.
Figure 3:
Figure 3:
Sequences of combined transapical aortic valve implantation (a–c) and percutaneous coronary intervention (d–f) of the mid left anterior descending artery (arrow) in a 95-year old female patient.
Figure 4:
Figure 4:
Kaplan–Meier probability of survival after combined percutaneous coronary intervention and transapical aortic valve implantation.
See this image and copyright information in PMC

References

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