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Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
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Clinical Impact of Pre-Procedural Percutaneous Coronary Intervention in Low- and Intermediate-Risk Transcatheter

Max-Paul Winter1, Thomas M Hofbauer1, Philipp E Bartko1

  • 1Department of Cardiology, Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.

Journal of Personalized Medicine
|August 6, 2021
PubMed

Insights

Complete revascularization before transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS) in low- and intermediate-risk patients is safe. This strategy showed no difference in all-cause mortality compared to patients without significant coronary artery disease (CAD).

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Optimal treatment for coronary artery disease (CAD) in patients undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS) remains unclear, especially in low- and intermediate-risk populations.
  • Existing data are conflicting and primarily focus on high-risk patients.

Purpose of the Study:

  • To investigate the feasibility and safety of complete revascularization before TAVR in low- and intermediate-risk patients with severe AS.
  • To assess the impact of recent (<3 months) and prior (>3 months) complete revascularization on clinical outcomes.

Main Methods:

  • A cohort of 449 patients at low (STS score < 4%) and intermediate risk (STS score 4-8%) undergoing TAVR for severe AS was enrolled.
  • The study analyzed the influence of complete revascularization timing on all-cause mortality, the primary endpoint.
  • Cox regression analysis was used to evaluate the effect of recent revascularization on mortality.

Main Results:

  • 58% of patients had no or non-significant CAD; 18% had prior complete revascularization, and 24% had recent complete revascularization before TAVR.
  • Two-year all-cause mortality was similar between patients with recent revascularization (13.7%) and those with no or non-significant CAD (14.2%; p = 0.905).
  • Recent revascularization prior to TAVR did not significantly affect all-cause mortality in Cox regression analysis.

Conclusions:

  • Complete percutaneous revascularization performed shortly before TAVR is a safe strategy in low- and intermediate-risk patients with severe AS.
  • This approach is neutral regarding all-cause mortality, offering reassurance for clinical decision-making.

Keywords:
coronary artery diseaseintermediate-risklow-riskpercutaneous coronary interventiontranscatheter aortic valve replacement

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