Outcomes in Patients With Transcatheter Aortic Valve Replacement and Left Main Stenting

• DOI: 10.1016/j.jacc.2015.10.103
• Publication Date: 2016-02-22T21:33:20Z
• Authors: 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 Matar; James Mirocha; Wen Cheng; Murat E. Tuzcu; Horst Sievert; Josep Rodés-Cabau; Antonio Colombo; Ariel Finkelstein; Jean Fajadet; Raj R. Makkar
• Keywords: Male; Coronary Artery Disease; Coronary Angiography; Severity of Illness Index; Transcatheter Aortic Valve Replacement; 03 medical and health sciences; Percutaneous Coronary Intervention; 0302 clinical medicine; aortic valve stenosis; coronary artery disease; percutaneous coronary intervention; transcatheter aortic valve replacement; Aged, 80 and over; Aortic Valve Stenosis; Coronary Angiography; Coronary Artery Disease; Coronary Vessels; Echocardiography; Female; Follow-Up Studies; Humans; Male; Percutaneous Coronary Intervention; Retrospective Studies; Risk Factors; Severity of Illness Index; Tomography, X-Ray Computed; Transcatheter Aortic Valve Replacement; Treatment Outcome; Registries; Stents; Medicine (all); Cardiology and Cardiovascular Medicine; Risk Factors; Humans; Registries; Retrospective Studies; Aged, 80 and over; Aortic Valve Stenosis; Coronary Vessels; 3. Good health; Treatment Outcome; Echocardiography; Female; Stents; Cardiology and Cardiovascular Medicine; Tomography, X-Ray Computed; Follow-Up Studies

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.The primary objective of the TAVR-LM registry is to evaluate clinical outcomes in patients undergoing TAVR plus LM PCI.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.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.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.