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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
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Safety and effectiveness of a selective strategy for coronary artery revascularization before transcatheter aortic

Valeria Gasparetto1, Chiara Fraccaro, Giuseppe Tarantini

  • 1Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy. gasparetto.valeria@gmail.com

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|March 31, 2012
PubMed

Insights

A selective approach to coronary artery disease (CAD) treatment before Transcatheter Aortic Valve Implantation (TAVI) is safe. This strategy in CAD patients undergoing TAVI showed outcomes similar to those without CAD.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Management of Coronary Artery Disease (CAD) in patients undergoing Transcatheter Aortic Valve Implantation (TAVI) lacks established guidelines.
  • CAD is prevalent in patients referred for TAVI, necessitating evaluation of revascularization strategies.

Purpose of the Study:

  • To assess the safety and effectiveness of a selective percutaneous coronary intervention (PCI) strategy prior to TAVI.
  • To compare outcomes in TAVI patients with and without CAD.

Main Methods:

  • A prospective registry evaluated patients undergoing TAVI, with PCI performed selectively for significant coronary lesions before the procedure.
  • TAVI utilized either self-expandable or balloon-expandable prostheses via various percutaneous approaches.
  • Clinical and echocardiographic follow-up was conducted at multiple time points post-TAVI.

Main Results:

  • Of 191 TAVI patients, 113 (59.2%) had CAD. PCI was performed in 39 (20.4%) patients before TAVI without adverse events.
  • Thirty-day mortality was 4.2% and similar between CAD and no-CAD groups. Myocardial infarction occurred in 4.4% of CAD patients (P=0.06).
  • Overall mortality at follow-up (12.9 months) was 14.8% and comparable between groups (P=0.88).

Conclusions:

  • The incidence of CAD is high in patients undergoing TAVI.
  • A selective, clinically guided coronary revascularization strategy before TAVI appears safe.
  • This approach was associated with outcomes similar to TAVI patients without CAD.
Abstract

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