Outcomes in Patients with Transcatheter Aortic Valve Replacement and Left Main Stenting: the TAVR-LM Registry

Tarun Chakravarty, Rahul Sharma, Yigal Abramowitz, Samir Kapadia, Azeem Latib, Hasan Jilaihawi, Kanhaiya Lal Poddar, Gennaro Giustino, Henrique B. Ribeiro, Didier Tchetche, Benoit Monteil, Luca Testa, Giuseppe Tarantini, Michela Facchin, Thierry Lefèvre, Brian R. Lindman, Babak Hariri, Jigar Patel, Nobuyuki Takahashi, George MatarJames Mirocha, Wen Cheng, Murat E. Tuzcu, Horst Sievert, Josep Rodés-Cabau, Antonio Colombo, Ariel Finkelstein, Jean Fajadet, Raj R. Makkar

Research output: Contribution to journalArticlepeer-review

Abstract

Background A percutaneous approach with transcatheter aortic valve replacement (TAVR) and percutaneous coronary intervention (PCI) of the left main coronary artery (LM) is frequently used in high-risk patients with coexisting aortic stenosis and LM disease. Outcomes of TAVR plus LM PCI have not been previously reported. Objectives The primary objective of the TAVR-LM registry is to evaluate clinical outcomes in patients undergoing TAVR plus LM PCI. Methods Clinical, echocardiographic, computed tomographic, and angiographic characteristics were retrospectively collected in 204 patients undergoing TAVR plus LM PCI. In total, 128 matched patient pairs were generated by performing 1:1 case-control matching between 167 patients with pre-existing LM stents undergoing TAVR and 1,188 control patients undergoing TAVR without LM revascularization. Results One-year mortality (9.4% vs. 10.2%, p = 0.83) was similar between the TAVR plus LM PCI cohort and matched controls. One-year mortality after TAVR plus LM PCI was not different in patients with unprotected compared with protected LMs (7.8% vs. 8.1%, p = 0.88), those undergoing LM PCI within 3 months compared with those with LM PCI greater than 3 months before TAVR (7.4% vs. 8.6%, p = 0.61), and those with ostial versus nonostial LM stents (10.3% vs. 15.6%, p = 0.20). Unplanned LM PCI performed because of TAVR-related coronary complication, compared with planned LM PCI performed for pre-existing LM disease, resulted in increased 30-day (15.8% vs. 3.4%, p = 0.013) and 1-year (21.1% vs. 8.0%, p = 0.071) mortality. Conclusions Despite the anatomic proximity of the aortic annulus to the LM, TAVR plus LM PCI is safe and technically feasible, with short- and intermediate-term clinical outcomes comparable with those in patients undergoing TAVR alone. These results suggest that TAVR plus LM PCI is a reasonable option for patients who are at high risk for surgery.

Original languageEnglish
Pages (from-to)951-960
Number of pages10
JournalJournal of the American College of Cardiology
Volume67
Issue number8
DOIs
Publication statusPublished - Mar 1 2016

Keywords

  • aortic valve stenosis
  • coronary artery disease
  • percutaneous coronary intervention
  • transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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