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Coronary Revascularization after Transcatheter and Surgical Aortic Valve Replacement
Davide Gabbieri1, Federico Giorgi2, Greta Mascheroni1
1Cardiac Surgery Unit, Department of Medical-Surgical Cardiology, Hesperia Hospital Modena, 41125 Modena, Italy.
Journal of Clinical Medicine
|December 9, 2023
Summary
Transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) showed similar mid-term freedom from coronary revascularization. This real-world study found a low incidence of percutaneous coronary intervention (PCI) after both procedures in severe aortic stenosis patients.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Surgery
Background:
- Previous transcatheter aortic valve implantation (TAVI) trials had limited follow-up, hindering assessment of coronary revascularization rates.
- Determining the incidence of coronary revascularization post-TAVI versus surgical aortic valve replacement (SAVR) is crucial for patient management.
- This study addresses the need for real-world, mid-term data on coronary revascularization following TAVI and SAVR in severe aortic stenosis (AS).
Purpose of the Study:
- To investigate and compare the epidemiology of coronary revascularization after SAVR and TAVI in patients with severe AS.
- To analyze revascularization rates in patients with and without pre-existing coronary artery disease (CAD).
- To evaluate mid-term outcomes in a real-world, single-center setting.
Main Methods:
- A cohort of 1486 patients with AS underwent either SAVR or TAVI using Edwards balloon-expandable transcatheter heart valves (THVs) between 2010 and 2020.
- Hospital discharge records were used to determine the rate of ischemic events treated with percutaneous coronary intervention (PCI).
- A subgroup of patients without prior CAD was specifically analyzed.
Main Results:
- The 5-year overall survival rate was 78.2%.
- Freedom from PCI at 5 years was identical for both SAVR and TAVI groups (96.9%).
- Previous PCI was a significant predictor of subsequent revascularization (HR 4.86, p < 0.001), but the freedom from PCI curves did not differ significantly between the two valve replacement methods.
Conclusions:
- The incidence of coronary revascularization post-TAVI and SAVR was low (2.4%) even in an aged population, warranting further investigation in younger cohorts with longer follow-up.
- The evolution of Edwards balloon-expandable THVs did not compromise the feasibility of future percutaneous coronary intervention (PCI) or coronary angiography.
- Mid-term outcomes demonstrate comparable safety regarding coronary revascularization between TAVI and SAVR.
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