Coronary Access and Percutaneous Coronary Intervention up to 3 Years after Transcatheter Aortic Valve Implantation with a Balloon-Expandable Valve

Giuseppe Tarantini, Luca Nai Fovino, Pascal Le Prince, Olivier Darremont, Marina Urena, Antonio L. Bartorelli, Flavien Vincent, Tomas Hovorka, Yasmina Alcalá Navarro, Nicolas Dumonteil, Patrick Ohlmann, Olaf Wendler

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Coronary artery disease and aortic stenosis often coexist. Transcatheter aortic valve implantation (TAVI) has emerged as a valid therapeutic option for younger, lower-risk patients who may eventually require coronary artery disease treatment. Thus, post-TAVI coronary access (CA) and percutaneous coronary intervention are expected to increase. The purpose of this study was to retrospectively evaluate patients who were enrolled in the SOURCE 3 (SAPIEN 3 Aortic Bioprosthesis European Outcome) European registry for treatment with the balloon-expandable SAPIEN 3 transcatheter heart valve and underwent CA with or without percutaneous coronary intervention after TAVI. Methods: Baseline characteristics and clinical outcomes of patients with or without CA up to 3 years after TAVI were compared. A Kaplan-Meier estimate with a univariate model determined the impact of CA on cardiac mortality. Results: Of 1936 TAVI patients (mean age 81.6 years, 52% male), 68 (3.5%) had CA within 3 years (mean 441±332 days) after TAVI. At baseline, the logistic EuroSCORE was similar (20.2% versus 18.3%, P=0.2, CA and non-CA groups, respectively). Higher rates of coronary artery disease (76.5% versus 50.6%, P<0.001), myocardial infarction (20.6% versus 11.5%, P=0.03) and previous coronary artery bypass graft (22.1% versus 11.0%, P=0.01) were present in the CA group. In 100% of patients, CA was successfully achieved. The clinical success of percutaneous coronary intervention was 97.9%. Cardiovascular mortality was numerically higher in patients with CA than in those without CA. Conclusions: In the large SOURCE 3 European registry, CA was needed at 3-year follow-up after TAVI with a balloon-expandable valve in 3.5% of patients and was successful in all patients. The clinical success of percutaneous coronary intervention was 97.9%.

Original languageEnglish
Article numbere008972
JournalCirculation: Cardiovascular Interventions
Volume13
Issue number7
DOIs
Publication statusPublished - Jul 1 2020

Keywords

  • coronary access
  • coronary artery disease
  • heart valves
  • mortality
  • myocardial infarction
  • percutaneous coronary intervention
  • transcatheter aortic valve

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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