Journal ArticleDOI
Safety and effectiveness of a selective strategy for coronary artery revascularization before transcatheter aortic valve implantation
Valeria Gasparetto,Chiara Fraccaro,Giuseppe Tarantini,Paolo Buja,Augusto D'Onofrio,Ermela Yzeiraj,Demetrio Pittarello,G. Isabella,Gino Gerosa,Sabino Iliceto,Massimo Napodano +10 more
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TLDR
The safety and effectiveness of a selective percutaneous revascularization strategy before TAVI in a single‐center prospective registry is assessed.Abstract:
Objectives
We assessed the safety and effectiveness of a selective percutaneous revascularization strategy before TAVI in a single-center prospective registry.
Background
Management of Coronary Artery Disease (CAD) before Transcatheter Aortic Valve Implantation (TAVI) is not yet established.
Methods
Percutaneous Coronary Intervention (PCI) was scheduled in proximal-to-mid coronary segment lesions on major coronary branches. TAVI was performed by percutaneous trans-femoral, trans-subclavian or trans-apical approach, using either the self-expandable III generation CoreValve (Medtronic, Minneapolis, Minnesota USA) or the Edwards SAPIEN™/SAPIEN XT balloon-expandable prosthesis (Edwards Lifesciences Irvine, CA). Clinical and echocardiographic follow-up was collected at 30-day, 3,6,12-month and yearly thereafter.
Results
Out of 191 patients who underwent TAVI, 113 (59.2%) had CAD. Mean age was 80.5 ± 6.9 years (57.6% female), logistic EuroSCORE was 21.4% ± 13.4. Twenty-seven (14.1%) patients had previous percutaneous and 29 (15.2%) surgical revascularization. PCI was performed as scheduled before TAVI in 39 (20.4%) patients, without adverse events. Complete anatomical revascularization was obtained in 38 of 113 CAD patients (33.6%). After TAVI, 30-day mortality was 4.2%, and was comparable between CAD and no-CAD patients (P = ns), while 30-day myocardial infarction incidence was 2.6% and occurred only in the CAD group (4.4%, P = 0.06). Overall mortality at follow-up (12.9 ± 9.5 months) was 14.8%, without difference between groups (P = 0.88). At follow-up, five patients underwent coronary revascularization.
Conclusions
In this study, the incidence of CAD is high in patients referred for TAVI. A selective, clinical based, coronary revascularization before TAVI seemed to be safe, and was associated with an outcome similar to those observed in no-CAD TAVI patients. © 2012 Wiley Periodicals, Inc.read more
Citations
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Journal Article
Transcatheter Valve Implantation for Patients with Aortic Stenosis : a position statement from the European Association of Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI)
TL;DR: Transcatheter aortic valve implantation is a promising technique, which may offer an alternative to conventional surgery for high-risk patients with aorta stenosis and may be extended to lower risk patients if the initial promise holds to be true after careful evaluation.
Journal ArticleDOI
Long-Term Survival of Patients With Radiation Heart Disease Undergoing Cardiac Surgery A Cohort Study
Willis Wu,Ahmad Masri,Zoran B. Popović,Nicholas G. Smedira,Bruce W. Lytle,Thomas H. Marwick,Brian P. Griffin,Milind Y. Desai +7 more
TL;DR: In this paper, the authors measured long-term survival in radiation-associated heart disease (RAHD) patients undergoing CTS, to compare them with a matched control population undergoing similar surgical procedures, and to identify potential predictors of longterm survival.
Journal ArticleDOI
Transcatheter Aortic Valve Implantation With or Without Percutaneous Coronary Artery Revascularization Strategy: A Systematic Review and Meta‐Analysis
Rafail A. Kotronias,Chun Shing Kwok,Sudhakar George,Davide Capodanno,Peter Ludman,Jonathan N. Townend,Sagar N. Doshi,Saib Khogali,Philippe Généreux,Howard C. Herrmann,Mamas A. Mamas,Rodrigo Bagur +11 more
TL;DR: It is suggested that revascularization before transcatheter aortic valve implantation confers no clinical advantage with respect to several patient‐important clinical outcomes and may be associated with an increased risk of major vascular complications and 30‐day mortality.
Journal ArticleDOI
Mid-term prognostic value of coronary artery disease in patients undergoing transcatheter aortic valve implantation: a meta-analysis of adjusted observational results.
Fabrizio D'Ascenzo,Federico Conrotto,Francesca Giordana,Claudio Moretti,Maurizio D'Amico,Stefano Salizzoni,P. Omede,M. La Torre,Martyn Thomas,Z. Khawaja,David Hildick-Smith,Ussia Gp,Marco Barbanti,Marco Barbanti,Corrado Tamburino,John G. Webb,Renate B. Schnabel,Moritz Seiffert,S. Wilde,Hendrik Treede,Valeria Gasparetto,Massimo Napodano,G. Tarantini,Patrizia Presbitero,Marco G. Mennuni,Marco Rossi,Mauro Gasparini,G. Biondi Zoccai,M. Lupo,Mauro Rinaldi,Fiorenzo Gaita,Sebastiano Marra +31 more
TL;DR: In this article, a meta-analysis aims to clarify the prognostic role of coronary artery disease on mid-term survival in patients undergoing TAVI, showing that diagnosis of CAD did not increase risk of death (OR 1.0, 95% CI, confidence interval, 0.67-1.50 I 2 0%).
Journal ArticleDOI
Aortic stenosis and coronary artery disease: What do we know? What don't we know? A comprehensive review of the literature with proposed treatment algorithms
Jean-Michel Paradis,Justin Fried,Tamim Nazif,Ajay J. Kirtane,Kishore J. Harjai,Omar K. Khalique,Kendra Grubb,Isaac George,Rebecca T. Hahn,Mathew R. Williams,Martin B. Leon,Susheel Kodali +11 more
TL;DR: This article includes a comprehensive review of the literature and seeks to describe the actual knowledge on the topic of aortic stenosis and concomitant coronary artery disease.
References
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Guidelines on the management of valvular heart disease The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology
Alec Vahanian,Helmut Baumgartner,Jeroen J. Bax,Butchart Eg,Robert Dion,Gerasimos Filippatos,Frank A. Flachskampf,Roger Hall,Bernard Iung,Jarosław D. Kasprzak,Patrick Nataf,Pilar Tornos,Lucia Torracca,Arnold Wenink,Silvia G. Priori,Jean-Jacques Blanc,Andrzej Budaj,John Camm,Veronica Dean,Jaap W. Deckers,Kenneth Dickstein,John Lekakis,Keith McGregor,Marco Metra,João Morais,Ady Osterspey,Juan Tamargo,José Luis Zamorano,Annalisa Angelini,Manuel J. Antunes,Miguel Ángel García Fernández,Christa Gohlke-Baerwolf,Gilbert Habib,John J.V. McMurray,Catherine M Otto,Luc Pierard,José L. Pomar,Bernard Prendergast,Raphael Rosenhek,Miguel Sousa Uva +39 more
TL;DR: Guidelines and Expert Consensus Documents aim to present management recommendations based on all of the relevant evidence on a particular subject in order to help physicians select the best possible management strategies for the individual patient suffering from a specific condition, taking into account the impact on outcome and also the risk–benefit ratio of a particular diagnostic or therapeutic procedure.
Journal ArticleDOI
Standardized Endpoint Definitions for Transcatheter Aortic Valve Implantation Clinical Trials : A Consensus Report From the Valve Academic Research Consortium
Martin B. Leon,Nicolo Piazza,Eugenia Nikolsky,Eugene H. Blackstone,Donald E. Cutlip,Arie Pieter Kappetein,Mitchell W. Krucoff,Michael J. Mack,Roxana Mehran,Craig Miller,Marie-Angèle Morel,John L. Petersen,Jeffrey J. Popma,Johanna J.M. Takkenberg,Alec Vahanian,Gerrit-Anne van Es,Pascal Vranckx,John G. Webb,Stephan Windecker,Patrick W. Serruys +19 more
TL;DR: Although consensus criteria will invariably include certain arbitrary features, an organized multidisciplinary process to develop specific definitions for TAVI clinical research should provide consistency across studies that can facilitate the evaluation of this new important catheter-based therapy.
Journal ArticleDOI
Prospective Study of Asymptomatic Valvular Aortic Stenosis Clinical, Echocardiographic, and Exercise Predictors of Outcome
Catherine M Otto,Ian G. Burwash,Malcolm E. Legget,Brad Munt,Michelle Fujioka,Nancy L. Healy,Carol D. Kraft,Carolyn Y. Miyake-Hull,Rebecca Gibbons Schwaegler +8 more
TL;DR: In adults with asymptomatic AS, the rate of hemodynamic progression and clinical outcome are predicted by jet velocity, the rates of change inJet velocity, and functional status.
Journal ArticleDOI
2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease
Journal ArticleDOI
Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European Association of Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI)
Alec Vahanian,Ottavio Alfieri,Nawwar Al-Attar,Manuel J. Antunes,Jeroen Bax,Bertrand Cormier,Alain Cribier,Peter De Jaegere,Gerard Fournial,Arie Pieter Kappetein,Jan Kovac,Susanne Ludgate,Francesco Maisano,Neil Moat,Friedrich W. Mohr,Patrick Nataf,Luc Pierard,José Luis Pomar,Joachim Schofer,Pilar Tornos,Murat Tuzcu,Ben van Hout,Ludwig K. von Segesser,Thomas Walther +23 more
TL;DR: Transcatheter aortic valve implantation is a promising technique, which may offer an alternative to conventional surgery for high-risk patients with aorta stenosis and may be extended to lower risk patients if the initial promise holds to be true after careful evaluation.
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