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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Outcomes of Transcatheter Aortic Valve Replacement With and Without Index Chronic Total Occlusion of Coronary Artery:

Mohammed Faisaluddin1, Yasar Sattar2, Nouraldeen Manasrah3

  • 1Department of Internal Medicine, Rochester General Hospital, Rochester, New York.

The American Journal of Cardiology
|August 20, 2023
PubMed

Insights

Transcatheter aortic valve replacement (TAVR) in patients with chronic total coronary occlusion (CTO) is safe but linked to higher risks of heart attack, cardiac arrest, and need for circulatory support. Outcomes show increased hospital stay and costs for TAVR-CTO patients.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Health Services Research

Background:

  • Transcatheter aortic valve replacement (TAVR) is increasingly utilized for aortic stenosis.
  • Coronary artery disease, including chronic total occlusion (CTO), is common in TAVR candidates.
  • The safety and outcomes of TAVR in patients with concomitant CTO are not well-established.

Purpose of the Study:

  • To evaluate the clinical characteristics, procedural safety, and outcomes of TAVR in patients with concomitant CTO.
  • To compare TAVR outcomes between patients with and without CTO lesions.

Main Methods:

  • Analysis of the National Inpatient Sample database from October 2015 to December 2020.
  • Inclusion of patients who underwent TAVR, comparing those with CTO (TAVR-CTO) versus those without (TAVR-no CTO).
  • Propensity score matching was used to adjust for baseline differences between groups.

Main Results:

  • A total of 304,330 TAVRs were analyzed; 1.72% had concomitant CTO.
  • No significant difference in in-hospital mortality between TAVR-CTO and TAVR-no CTO groups.
  • TAVR-CTO was associated with increased acute myocardial infarction (aOR 1.27), cardiac arrest (aOR 2.60), and need for mechanical circulatory support (aOR 2.60).
  • No differences in stroke, major bleeding, or complete heart block.
  • TAVR-CTO cohort experienced longer hospital stays and higher hospitalization costs.

Conclusions:

  • TAVR is a relatively safe procedure for patients with concomitant CTO.
  • However, TAVR in patients with CTO carries a higher risk of acute myocardial infarction, cardiac arrest, and need for mechanical circulatory support.
  • Increased length of stay and hospitalization costs are associated with TAVR in CTO patients.

Keywords:
acute myocardial infarctionchronic total occlusiontranscatheter aortic valve replacement

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