Outcomes of a hybrid approach of percutaneous coronary intervention followed by minimally invasive aortic valve replacement

Abstract

Background: In patients requiring coronary revascularization and aortic valve replacement, a combined approach of percutaneous coronary intervention followed by minimally invasive aortic valve replacement may be a viable treatment strategy.Methods: The outcomes of 123 consecutive patients with significant coronary artery and aortic valve disease, who underwent percutaneous coronary intervention followed by elective minimally invasive aortic valve replacement between February 2009 and April 2014, were retrospectively evaluated. Results:The cohort consisted of 80 males and 43 females, with a mean age of 75.7±8.1 years. Drug-eluting stents were used in 69.9% of the patients, and 64.2% were on dual anti-platelet therapy at the time of aortic valve replacement. Within a median of 39 days (IQR 21-64), 83.7% of the patients underwent primary and 16.3% underwent re-operative minimally invasive aortic valve replacement. Post-operatively, there was 1 (0.8%) cerebrovascular accident, 1 patient (0.8%) required a re-operation due to bleeding, and 2 (1.6%) developed acute kidney injury. Thirty-day mortality occurred in 2 (1.6%) patients. Follow-up was available for all of the patients, and at a mean follow-up period of 14.3±12.5 months, 4 (3.3%) had an acute coronary syndrome, and 1 (0.8%) required a repeat target vessel revascularization. The actuarial survival rate at 1-and 3-year was 92.7% and 89.4%, respectively. Conclusions:In a select group of patients with coronary artery and aortic valve disease, a combined approach of percutaneous coronary intervention followed by minimally invasive aortic valve replacement can be safely performed with excellent short-term and midterm outcomes.

Complete transcatheter versus complete surgical management for combined aortic stenosis and coronary artery disease: A false dichotomy?

“…In particular, reports of combined TAVI with off-pump CABG or minimally invasive direct CABG have generated some enthusiasm, [10][11][12][13][14] although concerns do still exist regarding their potentially increased in-hospital mortality compared with TAVI-PCI, along with their potentially higher in-hospital mortality, 12-month mortality, and rehospitalization rates when compared with SAVR-CABG. 15 Conversely, reports of staged minimally invasive valve surgery and PCI have also been published with promising results, [16][17][18][19] though this approach is limited through PCI's decreased efficacy with more complex coronary lesions. Although the TAVI outcomes have been improved during the last decade, 20 further increasing operative experience, optimizing patient selection, and definitively determining the timing of the different aspects of these interventions may all improve the outcomes of these budding options for patients with concomitant AS and CAD.…”