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

Tarun Chakravarty, Rahul Sharma, Yigal Abramowitz, Samir R. Kapadia, Azeem Latib, Hasan Jilaihawi, Kanhaiya L. 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 Tuzcu, Horst Sievert, J. Rodes Cabau, Antonio Colombo, Ariel Finkelstein, Jean Fajadet, Raj Makkar

Research output: Contribution to journalArticle

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

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Percutaneous Coronary Intervention
Registries
Transcatheter Aortic Valve Replacement
Stents
Mortality
Preexisting Condition Coverage
Aortic Valve Stenosis
Coronary Vessels

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Outcomes in Patients with Transcatheter Aortic Valve Replacement and Left Main Stenting : the TAVR-LM Registry. / Chakravarty, Tarun; Sharma, Rahul; Abramowitz, Yigal; Kapadia, Samir R.; Latib, Azeem; Jilaihawi, Hasan; Poddar, Kanhaiya L.; Giustino, Gennaro; Ribeiro, Henrique B.; Tchetche, Didier; Monteil, Benoit; Testa, Luca; Tarantini, Giuseppe; Facchin, Michela; Lefèvre, Thierry; Lindman, Brian R.; Hariri, Babak; Patel, Jigar; Takahashi, Nobuyuki; Matar, George; Mirocha, James; Cheng, Wen; Tuzcu, Murat; Sievert, Horst; Rodes Cabau, J.; Colombo, Antonio; Finkelstein, Ariel; Fajadet, Jean; Makkar, Raj.

In: Journal of the American College of Cardiology, Vol. 67, No. 8, 01.03.2016, p. 951-960.

Research output: Contribution to journalArticle

Chakravarty, T, Sharma, R, Abramowitz, Y, Kapadia, SR, Latib, A, Jilaihawi, H, Poddar, KL, Giustino, G, Ribeiro, HB, Tchetche, D, Monteil, B, Testa, L, Tarantini, G, Facchin, M, Lefèvre, T, Lindman, BR, Hariri, B, Patel, J, Takahashi, N, Matar, G, Mirocha, J, Cheng, W, Tuzcu, M, Sievert, H, Rodes Cabau, J, Colombo, A, Finkelstein, A, Fajadet, J & Makkar, R 2016, 'Outcomes in Patients with Transcatheter Aortic Valve Replacement and Left Main Stenting: the TAVR-LM Registry', Journal of the American College of Cardiology, vol. 67, no. 8, pp. 951-960. https://doi.org/10.1016/j.jacc.2015.10.103
Chakravarty, Tarun ; Sharma, Rahul ; Abramowitz, Yigal ; Kapadia, Samir R. ; Latib, Azeem ; Jilaihawi, Hasan ; Poddar, Kanhaiya L. ; Giustino, Gennaro ; Ribeiro, Henrique B. ; Tchetche, Didier ; Monteil, Benoit ; Testa, Luca ; Tarantini, Giuseppe ; Facchin, Michela ; Lefèvre, Thierry ; Lindman, Brian R. ; Hariri, Babak ; Patel, Jigar ; Takahashi, Nobuyuki ; Matar, George ; Mirocha, James ; Cheng, Wen ; Tuzcu, Murat ; Sievert, Horst ; Rodes Cabau, J. ; Colombo, Antonio ; Finkelstein, Ariel ; Fajadet, Jean ; Makkar, Raj. / Outcomes in Patients with Transcatheter Aortic Valve Replacement and Left Main Stenting : the TAVR-LM Registry. In: Journal of the American College of Cardiology. 2016 ; Vol. 67, No. 8. pp. 951-960.
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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.",
keywords = "aortic valve stenosis, coronary artery disease, percutaneous coronary intervention, transcatheter aortic valve replacement",
author = "Tarun Chakravarty and Rahul Sharma and Yigal Abramowitz and Kapadia, {Samir R.} and Azeem Latib and Hasan Jilaihawi and Poddar, {Kanhaiya L.} and Gennaro Giustino and Ribeiro, {Henrique B.} and Didier Tchetche and Benoit Monteil and Luca Testa and Giuseppe Tarantini and Michela Facchin and Thierry Lef{\`e}vre and Lindman, {Brian R.} and Babak Hariri and Jigar Patel and Nobuyuki Takahashi and George Matar and James Mirocha and Wen Cheng and Murat Tuzcu and Horst Sievert and {Rodes Cabau}, J. and Antonio Colombo and Ariel Finkelstein and Jean Fajadet and Raj Makkar",
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TY - JOUR

T1 - Outcomes in Patients with Transcatheter Aortic Valve Replacement and Left Main Stenting

T2 - the TAVR-LM Registry

AU - Chakravarty, Tarun

AU - Sharma, Rahul

AU - Abramowitz, Yigal

AU - Kapadia, Samir R.

AU - Latib, Azeem

AU - Jilaihawi, Hasan

AU - Poddar, Kanhaiya L.

AU - Giustino, Gennaro

AU - Ribeiro, Henrique B.

AU - Tchetche, Didier

AU - Monteil, Benoit

AU - Testa, Luca

AU - Tarantini, Giuseppe

AU - Facchin, Michela

AU - Lefèvre, Thierry

AU - Lindman, Brian R.

AU - Hariri, Babak

AU - Patel, Jigar

AU - Takahashi, Nobuyuki

AU - Matar, George

AU - Mirocha, James

AU - Cheng, Wen

AU - Tuzcu, Murat

AU - Sievert, Horst

AU - Rodes Cabau, J.

AU - Colombo, Antonio

AU - Finkelstein, Ariel

AU - Fajadet, Jean

AU - Makkar, Raj

PY - 2016/3/1

Y1 - 2016/3/1

N2 - 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.

AB - 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.

KW - aortic valve stenosis

KW - coronary artery disease

KW - percutaneous coronary intervention

KW - transcatheter aortic valve replacement

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DO - 10.1016/j.jacc.2015.10.103

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JO - Journal of the American College of Cardiology

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