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

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

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.

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.

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 cm(2) (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).

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.