Combined coronary artery revascularization and percutaneous aortic valve implantation in elderly patients

Abstract

The combination of coronary atery revascularization and transcatheter aortic valve implantation might increase the risk and have some influence in the outcome of elderly patients. We analyzed the influence of combined coronary artery revascularization on the outcome of patients with degenerative aortic stenosis treated by transcatheter aortic valve implantation (TAVI). Methods: Between April 2008 and December 2012, 191 patients with aortic stenosis were treated by TAVI (CoreValve); 139 (73%) had no significant coronary disease (group I), and 52 (27%) presented coronary artery disease that was treated percutaneously before TAVI implantation (group II). Patients were followed-up for a mean of 23(plus or minus)17 months. We defined major events as death, stroke, myocardial infarction or readmission for congestive heart failure (CHF). Results: The mean age at treatment was 78(plus or minus)5 years. Admission for rest angina was more frequent in patients from group II (22% vs 6%; p<0.05). There were no significant differences in baseline characteristics from group I and II, in terms of age, logistic EuroScore and incidence of diabetes, hypertension, smokers, atrial fibrillation, chronic pulmonary disease or chronic renal failure. Hemodynamic and angiographic baseline data were also similar in both groups (aortic valve area, left ventricular ejection fraction). In group II, 34 patients (66%) had single vessel disease and 18 (34%) multi-vessel disease. All these patients underwent stent implantation 2(plus or minus)1 months prior to TAVI. Drug-eluting stents were implanted in 23 (44%) patients, while 29 (56%) received bare metal stents. Both groups of patients received similar TAVI treatment, with no differences in terms of valve size, need for post-dilation or permanent pacemaker implantation. Procedural success was achieved in 137 patients (91%) in group I and in 47 patients (90%) in group II (p: ns), 12 patients (8.6%) died in hospital in group I and 2 patients (4%) in group II (p: ns). During follow-up, 10 patients (8%) presented late death in group I vs 9 (17%) in group II (p: ns). The incidence of stroke was 5 (3%) -group I-vs. 6 (11%) -group II- (p: ns). The readmission rate due to CHF was 8 (6%) -group I-vs 3 (6%) -group II- (p: ns). There were no myocardial infarction in both groups. The Kaplan Meier event free probability for major events at 3 years was 76% -group I-vs. 70% -group II- (p: ns). Conclusions: Co-existing coronary artery disease treated with percutaneous stenting does not seem to influence the outcome negatively in patients with degenerative aortic stenosis treated by TAVI.