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Complete revascularization is not a prerequisite for success in current transcatheter aortic valve implantation practice.

Abstract This study sought to assess in patients undergoing transcatheter aortic valve implantation (TAVI), the prevalence and impact of incomplete coronary revascularization defined as >50% coronary artery or graft diameter stenosis on visual assessment of the coronary angiogram.
PMID
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Authors

Mayor MeshTerms

Cardiac Catheterization

Percutaneous Coronary Intervention

Keywords

ACS

AS

CABG

CAD

IQR

PCI

SAVR

SYNTAX score

TAVI

acute coronary syndrome

aortic valve stenosis

coronary artery bypass grafting

coronary artery disease

interquartile range

percutaneous coronary intervention

revascularization

surgical aortic valve replacement

transcatheter aortic valve implantation

Journal Title jacc. cardiovascular interventions
Publication Year Start




PMID- 23871511
OWN - NLM
STAT- MEDLINE
DCOM- 20140324
LR  - 20161125
IS  - 1876-7605 (Electronic)
IS  - 1936-8798 (Linking)
VI  - 6
IP  - 8
DP  - 2013 Aug
TI  - Complete revascularization is not a prerequisite for success in current
      transcatheter aortic valve implantation practice.
PG  - 867-75
LID - 10.1016/j.jcin.2013.04.015 [doi]
LID - S1936-8798(13)00993-X [pii]
AB  - OBJECTIVES: This study sought to assess in patients undergoing transcatheter
      aortic valve implantation (TAVI), the prevalence and impact of incomplete
      coronary revascularization defined as >50% coronary artery or graft diameter
      stenosis on visual assessment of the coronary angiogram. BACKGROUND: TAVI is an
      established treatment option in elderly patients with aortic stenosis (AS) and a 
      (very) high operative risk. Coronary artery disease (CAD) is often associated
      with AS. METHODS: A single-center cohort of consecutive patients undergoing TAVI 
      between November 2005 and June 2012 was evaluated for the presence of significant
      CAD. The decision to revascularize and pursue complete revascularization was made
      by heart team consensus. RESULTS: A total of 263 consecutive patients with a mean
      age of 80 +/- 7 years and 51% male underwent TAVI with a median follow-up
      duration of 16 months (interquartile range: 4.2 to 28.1 months). Significant CAD 
      with myocardium at risk was present in 124 patients (47%), 44 of whom had had
      previous coronary artery bypass grafting (CABG), and the median SYNTAX score in
      the 81 patients without previous CABG was 9.00 (2.38 to 15.63). Staged
      percutaneous coronary intervention (PCI) was planned in 19 (15%) and concomitant 
      PCI with TAVI in 20 (16%). The median post-procedural residual SYNTAX score of
      patients without prior CABG was 5.00 (0.13 to 9.88). Overall, 99 patients (37%)
      (61 with no CABG and 38 CABG patients) had incomplete revascularization after
      TAVI. Revascularization status did not affect clinical endpoints. Kaplan-Meier
      survival curves for patients with and without complete revascularization
      demonstrated a 1-year mortality of 79.9% versus 77.4% (p = 0.85), respectively.
      CONCLUSIONS: In an elderly patient population undergoing TAVI for severe AS, a
      judicious revascularization strategy selection by a dedicated heart team can
      generate favorable mid-term outcome obviating the need for complete coronary
      revascularization.
CI  - Copyright (c) 2013 American College of Cardiology Foundation. Published by
      Elsevier Inc. All rights reserved.
FAU - Van Mieghem, Nicolas M
AU  - Van Mieghem NM
AD  - Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center,
      Rotterdam, The Netherlands. [email protected]
FAU - van der Boon, Robert M
AU  - van der Boon RM
FAU - Faqiri, Elhamula
AU  - Faqiri E
FAU - Diletti, Roberto
AU  - Diletti R
FAU - Schultz, Carl
AU  - Schultz C
FAU - van Geuns, Robert-Jan
AU  - van Geuns RJ
FAU - Serruys, Patrick W
AU  - Serruys PW
FAU - Kappetein, Arie-Pieter
AU  - Kappetein AP
FAU - van Domburg, Ron T
AU  - van Domburg RT
FAU - de Jaegere, Peter P
AU  - de Jaegere PP
LA  - eng
PT  - Journal Article
DEP - 20130717
PL  - United States
TA  - JACC Cardiovasc Interv
JT  - JACC. Cardiovascular interventions
JID - 101467004
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Aortic Valve Stenosis/complications/diagnosis/mortality/*therapy
MH  - *Cardiac Catheterization/adverse effects/mortality
MH  - Chi-Square Distribution
MH  - Coronary Angiography
MH  - Coronary Artery Bypass
MH  - Coronary Stenosis/complications/diagnostic imaging/mortality/*therapy
MH  - Female
MH  - Heart Valve Prosthesis Implantation/adverse effects/*methods/mortality
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Logistic Models
MH  - Male
MH  - Netherlands
MH  - Patient Care Team
MH  - *Percutaneous Coronary Intervention/adverse effects/mortality
MH  - Prospective Studies
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - Severity of Illness Index
MH  - Time Factors
MH  - Treatment Outcome
OTO - NOTNLM
OT  - ACS
OT  - AS
OT  - CABG
OT  - CAD
OT  - IQR
OT  - PCI
OT  - SAVR
OT  - SYNTAX score
OT  - TAVI
OT  - acute coronary syndrome
OT  - aortic valve stenosis
OT  - coronary artery bypass grafting
OT  - coronary artery disease
OT  - interquartile range
OT  - percutaneous coronary intervention
OT  - revascularization
OT  - surgical aortic valve replacement
OT  - transcatheter aortic valve implantation
EDAT- 2013/07/23 06:00
MHDA- 2014/03/25 06:00
CRDT- 2013/07/23 06:00
PHST- 2013/01/28 00:00 [received]
PHST- 2013/04/12 00:00 [revised]
PHST- 2013/04/18 00:00 [accepted]
PHST- 2013/07/23 06:00 [entrez]
PHST- 2013/07/23 06:00 [pubmed]
PHST- 2014/03/25 06:00 [medline]
AID - S1936-8798(13)00993-X [pii]
AID - 10.1016/j.jcin.2013.04.015 [doi]
PST - ppublish
SO  - JACC Cardiovasc Interv. 2013 Aug;6(8):867-75. doi: 10.1016/j.jcin.2013.04.015.
      Epub 2013 Jul 17.