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Tarantini G, Nai Fovino L, Leprince P, Darremont O, Urena M, Bartorelli AL, Vincent F, Hovorka T, Dumonteil N, Ohlmann P, Wendler O. P3737Predictors, feasibility and outcomes of coronary interventions up to 3 years after TAVI with a balloon-expandable valve. Results from a large European multicenter registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Coronary artery disease (CAD) and aortic stenosis often coexist. Transcatheter aortic valve implantation (TAVI) is emerging as a favorable treatment for younger and lower surgical risk patients. The need for coronary angiography (CA) and percutaneous coronary intervention (PCI) after TAVI will thus increase.
Purpose
We retrospectively evaluated the outcome of PCI performed after TAVI with the balloon-expandable SAPIEN 3 transcatheter heart valve in the SOURCE 3 European registry.
Methods
Cardiovascular (CV) mortality was computed at 3 years for patients with PCI and for those without. Univariate and Cox multivariate models were developed to assess the potential impact of PCI on CV mortality.
Results
Out of 1939 TAVI patients, 44 (2.3%) underwent PCI within 3 years after TAVI (mean interval from TAVI: 428±341 days). Patients with PCI were 80.9 years old and 63.6% were male. They had higher baseline logistic EuroSCORE (22.6% vs. 18.3%, p=0.007), higher rate of prior CAD diagnosis (72.7% vs. 51.0%, p=0.005), prior PCI (45.5% vs. 33.6%, p=0.108) and previous CABG (25.0% vs. 11.0%, p=0.013) than other patients of the cohort. Coronary access (ability to cannulate selectively the coronaries) was feasible in 100% of patients; PCI was successful in all but one case. The univariate model showed that CV mortality was slightly higher in patients undergoing PCI compared with those without PCI (Hazard Ratio: 1.86 [0.96–3.59], p=0.07); CV mortality rate was even lower with the multivariate model (HR: 1.39, p=0.52).
Conclusions
Interventions of CA and PCI after TAVI with a balloon-expandable valve was feasible and successful in all but one case in this large European registry. There was a trend towards a worse CV mortality at 3 years in patients needing PCI, which did not reach statistical significance likely because of the low incidence of PCI in our TAVI population.
Acknowledgement/Funding
The SOURCE 3 registry is sponsored by Edwards Lifesciences
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Affiliation(s)
- G Tarantini
- University Hospital of Padova, Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - L Nai Fovino
- University Hospital of Padova, Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - P Leprince
- Hospital Pitie-Salpetriere, Sorbonne University, Paris, France
| | | | - M Urena
- Hospital Bichat-Claude Bernard, Paris, France
| | - A L Bartorelli
- Cardiology Center Monzino IRCCS, University of Milan, Milan, Italy
| | | | - T Hovorka
- Edwards Lifesciences, Biostatistics Department, Prague, Czechia
| | | | - P Ohlmann
- University Hospital of Strasbourg, Interventional Cardiology Department, Strasbourg, France
| | - O Wendler
- Kings College Hospital, London, United Kingdom
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