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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
08:50

Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement

Published on: March 26, 2018

Management of high-risk patients with aortic stenosis and coronary artery disease

Daniel Wendt1, Philipp Kahlert, Tim Lenze

  • 1Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Hospital Essen, Essen, Germany. daniel.wendt@uk-essen.de

The Annals of Thoracic Surgery
|October 2, 2012
PubMed

Insights

Transcatheter aortic valve implantation with percutaneous coronary intervention is a safe and effective alternative to surgical aortic valve replacement and bypass grafting for high-risk patients. Both strategies show similar 30-day mortality rates in this patient group.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Surgical aortic valve replacement (SAVR) with coronary artery bypass grafting (CABG) is the standard treatment for patients with aortic stenosis and coronary artery disease.
  • Transcatheter aortic valve implantation (TAVI) combined with percutaneous coronary intervention (PCI) is an emerging alternative strategy for high-risk patients.

Purpose of the Study:

  • To compare the efficacy and safety of TAVI + PCI versus SAVR + CABG in high-risk patients.
  • To determine if TAVI + PCI is an equivalent strategy to SAVR + CABG regarding 30-day mortality.

Main Methods:

  • A total of 243 high-risk patients were studied, divided into two groups: SAVR + CABG (n=184) and PCI within 12 months before TAVI (n=59).
  • Propensity score-adjusted regression analysis was used to compare 30-day mortality, the primary endpoint.
  • Patient characteristics, including age, EuroSCORE, and STS score, were analyzed.

Main Results:

  • The TAVI + PCI group had a higher mean age and higher EuroSCORE and STS scores compared to the SAVR + CABG group (p < 0.001).
  • Thirty-day mortality was similar between the groups: 12.5% for SAVR + CABG and 11.9% for TAVI + PCI (odds ratio 0.94, p = 0.89).
  • Risk-adjusted analysis confirmed no significant difference in 30-day mortality between the two treatment strategies (p = 0.44).

Conclusions:

  • TAVI combined with prior PCI is a viable and equivalent alternative to SAVR + CABG in high-risk patients with aortic stenosis and coronary artery disease.
  • The study demonstrates similar outcomes for both treatment strategies in a propensity score-matched high-risk population.
Abstract

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