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Outcomes of concomitant percutaneous coronary intervention and balloon aortic valvuloplasty
Itsik Ben-Dor1, Gabriel Maluenda, Patrick M Looser
1Division of Cardiology, Washington Hospital Center, Washington, DC.
Insights
Combined balloon aortic valvuloplasty (BAV) and percutaneous coronary intervention (PCI) are safe for patients with severe aortic stenosis and coronary artery disease. This combined approach shows similar complication rates to BAV alone.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Coronary artery disease frequently coexists with severe aortic stenosis.
- The safety and feasibility of combining balloon aortic valvuloplasty (BAV) with percutaneous coronary intervention (PCI) remain under investigation.
Purpose of the Study:
- To compare the outcomes and complication rates of combined BAV and PCI versus BAV alone in patients with severe aortic stenosis.
Main Methods:
- A cohort of 409 patients with severe aortic stenosis undergoing BAV between 2007 and 2010 was analyzed.
- 329 patients underwent BAV alone, while 80 patients received concomitant PCI.
- Clinical, hemodynamic, and procedural data were collected to assess acute and intermediate-term outcomes.
Main Results:
- The combined BAV/PCI group experienced longer procedure and fluoroscopy times and required more contrast dye.
- Serious adverse events, transfusion rates, and periprocedural elevations in troponin or creatinine were similar between groups.
- Mortality rates at a mean follow-up of approximately 180 days were comparable (48.6% for BAV alone vs. 40% for BAV/PCI).
Conclusions:
- Combined BAV and PCI is a safe procedure for patients with severe aortic stenosis and coronary artery disease.
- The complication profile of combined BAV and PCI is similar to BAV alone.
- This combined intervention may provide protection against myocardial ischemia during BAV.
Background:
Coronary artery disease often coexists with severe aortic stenosis. The feasibility and safety of combined balloon aortic valvuloplasty (BAV) and percutaneous coronary intervention (PCI) are unknown.
Aim:
To compare outcomes and complications of combined BAV and PCI with BAV alone.
Methods:
The study cohort consisted of 409 patients with severe aortic stenosis undergoing BAV from 1/2007 to 12/2010. Overall, 329 patients underwent BAV alone and 80 underwent concomitant PCI. Clinical and hemodynamic data, as well as acute and intermediate-term outcomes, were collected.
Results:
At the operator's discretion PCI was done before BAV in 66 (82.5%) and after in 14 (17.5%). Patients who underwent concomitant procedures had a higher incidence of prior stroke and a lower incidence of atrial fibrillation. Procedure time and fluoroscopic time were significantly greater in the BAV/PCI group, (90.0 ± 36.6 vs. 72.8 ± 39.8, P = 0.002 and 20.5 ± 10.9 vs. 12.9 ± 7.0, P < 0.001). Significantly more radiographic contrast was used in the BAV/PCI group (95.1 ± 45.5 vs. 36.7 ± 38.4 cm(3) , P < 0.001. Serious adverse events occurred with equal frequency 13.7 and 17.3%, P = 0.44). Transfusion requirement was also similar (21.2% vs. 20.0%, P = 0.81). The frequency of a periprocedural increase in troponin or creatinine was also similar. In the BAV alone group the mortality rate was 48.6% (n = 160) during a mean follow-up of 191 days, and in the BAV/PCI group the mortality rate was 40% (n = 32) during mean follow-up of 175.5 day, P = 0.34.
Conclusion:
Combined BAV and PCI are safe and are associated with similar complications as BAV alone and may offer protection against myocardial ischemia during BAV.
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