Related Experiment Video
Updated: Mar 25, 2026
Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017
Outcomes in Patients With Transcatheter Aortic Valve Replacement and Left Main Stenting: The TAVR-LM Registry
Tarun Chakravarty1, Rahul Sharma1, Yigal Abramowitz2
1Cedars-Sinai Heart Institute, Los Angeles, California.
Insights
Transcatheter aortic valve replacement (TAVR) combined with percutaneous coronary intervention (PCI) for left main coronary artery (LM) disease is safe and feasible. Outcomes for TAVR plus LM PCI are comparable to TAVR alone in high-risk patients.
Area of Science:
- Interventional Cardiology
- Cardiovascular Surgery
- Structural Heart Disease
Background:
- High-risk patients often have coexisting aortic stenosis and left main (LM) coronary artery disease.
- Percutaneous coronary intervention (PCI) for LM disease and transcatheter aortic valve replacement (TAVR) are common in these patients.
- Clinical outcomes of combined TAVR and LM PCI have not been previously reported.
Purpose of the Study:
- To evaluate the clinical outcomes of patients undergoing TAVR plus LM PCI.
- To assess the safety and feasibility of this combined percutaneous approach.
- To compare outcomes with TAVR alone.
Main Methods:
- Retrospective collection of clinical, echocardiographic, computed tomographic, and angiographic data from 204 patients.
- 1:1 case-control matching created 128 pairs comparing TAVR with LM PCI to TAVR without LM revascularization.
- Analysis focused on one-year mortality and outcomes based on LM protection status and PCI timing.
Main Results:
- One-year mortality was similar between the TAVR plus LM PCI cohort and matched controls (9.4% vs. 10.2%, p = 0.83).
- Mortality was comparable for unprotected versus protected LMs and for early versus late LM PCI.
- Unplanned LM PCI due to TAVR complications increased 30-day and one-year mortality compared to planned PCI.
Conclusions:
- TAVR plus LM PCI is safe and technically feasible, despite the proximity of the aortic annulus to the LM.
- Short- and intermediate-term clinical outcomes are comparable to TAVR alone.
- This combined approach is a reasonable option for high-risk surgical patients.
Background:
A percutaneous approach with transcatheter aortic valve replacement (TAVR) and percutaneous coronary intervention (PCI) of the left main coronary artery (LM) is frequently used in high-risk patients with coexisting aortic stenosis and LM disease. Outcomes of TAVR plus LM PCI have not been previously reported.
Objectives:
The primary objective of the TAVR-LM registry is to evaluate clinical outcomes in patients undergoing TAVR plus LM PCI.
Methods:
Clinical, echocardiographic, computed tomographic, and angiographic characteristics were retrospectively collected in 204 patients undergoing TAVR plus LM PCI. In total, 128 matched patient pairs were generated by performing 1:1 case-control matching between 167 patients with pre-existing LM stents undergoing TAVR and 1,188 control patients undergoing TAVR without LM revascularization.
Results:
One-year mortality (9.4% vs. 10.2%, p = 0.83) was similar between the TAVR plus LM PCI cohort and matched controls. One-year mortality after TAVR plus LM PCI was not different in patients with unprotected compared with protected LMs (7.8% vs. 8.1%, p = 0.88), those undergoing LM PCI within 3 months compared with those with LM PCI greater than 3 months before TAVR (7.4% vs. 8.6%, p = 0.61), and those with ostial versus nonostial LM stents (10.3% vs. 15.6%, p = 0.20). Unplanned LM PCI performed because of TAVR-related coronary complication, compared with planned LM PCI performed for pre-existing LM disease, resulted in increased 30-day (15.8% vs. 3.4%, p = 0.013) and 1-year (21.1% vs. 8.0%, p = 0.071) mortality.
Conclusions:
Despite the anatomic proximity of the aortic annulus to the LM, TAVR plus LM PCI is safe and technically feasible, with short- and intermediate-term clinical outcomes comparable with those in patients undergoing TAVR alone. These results suggest that TAVR plus LM PCI is a reasonable option for patients who are at high risk for surgery.
Related Concept Videos
01:26Mitral Stenosis III: Medical Management
01:24Cardiac Catheterization III: Left Heart Catheterization