TY - JOUR
T1 - Complete Revascularization Is Not a Prerequisite for Success in Current Transcatheter Aortic Valve Implantation Practice
AU - van Mieghem, Nicolas
AU - van der Boon, Robert
AU - Faqiri, E
AU - Diletti, Roberto
AU - Schultz, Carl
AU - van Geuns, Robert Jan
AU - Serruys, PWJC (Patrick)
AU - Kappetein, Arie-Pieter
AU - van Domburg, Ron
AU - de Jaegere, Peter
PY - 2013
Y1 - 2013
N2 - Objectives This study sought to assess in patients undergoing transcatheter aortic valve implantation (TAVI), the prevalence and impact of incomplete coronary revascularization defined as >50% coronary artery or graft diameter stenosis on visual assessment of the coronary angiogram. Background TAVI is an established treatment option in elderly patients with aortic stenosis (AS) and a (very) high operative risk. Coronary artery disease (CAD) is often associated with AS. Methods A single-center cohort of consecutive patients undergoing TAVI between November 2005 and June 2012 was evaluated for the presence of significant CAD. The decision to revascularize and pursue complete revascularization was made by heart team consensus. Results A total of 263 consecutive patients with a mean age of 80 +/- 7 years and 51% male underwent TAVI with a median follow-up duration of 16 months (interquartile range: 4.2 to 28.1 months). Significant CAD with myocardium at risk was present in 124 patients (47%), 44 of whom had had previous coronary artery bypass grafting (CABG), and the median SYNTAX score in the 81 patients without previous CABG was 9.00 (2.38 to 15.63). Staged percutaneous coronary intervention (PCI) was planned in 19 ( Conclusions In an elderly patient population undergoing TAVI for severe AS, a judicious revascularization strategy selection by a dedicated heart team can generate favorable mid-term outcome obviating the need for complete coronary revascularization. (C) 2013 by the American College of Cardiology Foundation
AB - Objectives This study sought to assess in patients undergoing transcatheter aortic valve implantation (TAVI), the prevalence and impact of incomplete coronary revascularization defined as >50% coronary artery or graft diameter stenosis on visual assessment of the coronary angiogram. Background TAVI is an established treatment option in elderly patients with aortic stenosis (AS) and a (very) high operative risk. Coronary artery disease (CAD) is often associated with AS. Methods A single-center cohort of consecutive patients undergoing TAVI between November 2005 and June 2012 was evaluated for the presence of significant CAD. The decision to revascularize and pursue complete revascularization was made by heart team consensus. Results A total of 263 consecutive patients with a mean age of 80 +/- 7 years and 51% male underwent TAVI with a median follow-up duration of 16 months (interquartile range: 4.2 to 28.1 months). Significant CAD with myocardium at risk was present in 124 patients (47%), 44 of whom had had previous coronary artery bypass grafting (CABG), and the median SYNTAX score in the 81 patients without previous CABG was 9.00 (2.38 to 15.63). Staged percutaneous coronary intervention (PCI) was planned in 19 ( Conclusions In an elderly patient population undergoing TAVI for severe AS, a judicious revascularization strategy selection by a dedicated heart team can generate favorable mid-term outcome obviating the need for complete coronary revascularization. (C) 2013 by the American College of Cardiology Foundation
U2 - 10.1016/j.jcin.2013.04.015
DO - 10.1016/j.jcin.2013.04.015
M3 - Article
C2 - 23871511
SN - 1936-8798
VL - 6
SP - 867
EP - 875
JO - JACC-Cardiovascular interventions
JF - JACC-Cardiovascular interventions
IS - 8
ER -