Outcomes of concomitant percutaneous coronary interventions and transcatheter aortic valve replacement

Abstract

IntroductionCoronary artery disease is a common diagnosis among patients undergoing transcatheter aortic valve replacement (TAVR). The treatment and timing of percutaneous coronary intervention (PCI) remain controversial. We sought to compare in-hospital periprocedural outcomes of combined TAVR and PCI during the same index hospitalization versus the isolated TAVR procedure.Material and methodsThe study population was extracted from the 2016 Nationwide Readmissions Data (NRD) using International Classification of Diseases, tenth edition, clinical modifications/procedure coding system codes for TAVR, coronary PCI, and post-procedural complications. Study endpoints included in-hospital all-cause mortality, length of index hospital stay, cardiogenic shock, need for mechanical circulatory support (MCS) devices, mechanical complications of prosthetic valve, paravalvular leak (PVL), acute kidney injury (AKI), bleeding and total hospital charges. Propensity matching was used to adjust for baseline characteristics.ResultsThere were 23,604 TAVRs in the 2016 NRD, of which 852 were combined with PCI during the same index hospitalization. Mean age was 80.5 years and 45.9% were female. In comparison to isolated TAVR, TAVR-PCI was associated with higher in-hospital all-cause mortality (4.5% vs. 1.7%, p < 0.01), longer length of stay (10.5 vs. 5.4 days, p < 0.01), and higher incidence of cardiogenic shock (9.4% vs. 2.1%, p < 0.01), use of MCS devices (6.8% vs. 0.7%, p < 0.01), mechanical complications of prosthetic valve (6.8% vs. 0.7%, p < 0.01), PVL (0.9% vs. 0.4%, p = 0.01), AKI (25.5% vs. 11.5%, p < 0.01), bleeding (25.2% vs. 18.1%, p < 0.01), and total hospital charges ($354,725 vs. $220474, p < 0.01).ConclusionsIn comparison to isolated TAVR, combined TAVR-PCI was associated with a higher incidence of in-hospital morbidity and mortality. The association and mechanism of increased mortality warrant further study.

Updates on the Role of Interventional Radiology in Ischemic Patients Undergoing Aortic Valve Replacement: Systematic Review

“…The PCI technique could be adopted for the majority of TF-TAVI treatments since it seems to be a safe and effective therapeutic pathway that offers an adequate and sensible usage of anaesthesiology resources (Denimal et al, 2021). We also found a high mortality risk and complications such as stroke (Guedeney et al, 2019), vascular injury (Abugroun et al, 2020), and hospital morbidity (Ghrair et al, 2020) among the target population. Temporary circulatory disturbances during balloon valvuloplasty or rapid ventricular pacing, embolism due to the separation of calcium deposits, and enhanced thrombogenicity brought on by tissue factor release are some of the reasons that may affect stroke and vascular damage in TAVR.…”

“…A total of 6252 patients were included. Five studies were conducted in the USA (Jeroudi et al, 2018;Guedeney et al, 2019;Abugroun et al, 2020;Ghrair et al, 2020;Tran et al, 2022), two in Switzerland (Winter et al, 2021;Perrin et al, 2022), two in France (Denimal et al, 2021;Matta et al, 2021), one in Japan (Kaihara et al, 2021), and one in Canada (Ferreira-Neto et al, 2019). Table 2 presents the characteristics of the included studies.…”

“…Table 2 presents the characteristics of the included studies. Nine studies are retrospective in nature (Ferreira-Neto et al, 2017;Jeroudi et al, 2018;Ghrair et al, 2020;Denimal et al, 2021;Kaihara et al, 2021;Matta et al, 2021;Perrin et al, 2022), and two are prospective studies (Guedeney et al, 2019;Winter et al, 2021). The SE, balloon-expandable, ES, and CoreValve are the most common valve types used in TAVI or TAVR.…”

“…The majority of the included studies reported that TAVI/ TAVR combined with the PCI technique is a safe and efficacious procedure for managing patients with AS. A high risk of mortality was reported in three studies (Guedeney et al, 2019;Ghrair et al, 2020;Tran et al, 2022). Complications such as stroke (Guedeney et al, 2019), vascular injury (Abugroun et al, 2020), and hospital morbidity (Ghrair et al, 2020) were recorded.…”

“…A high risk of mortality was reported in three studies (Guedeney et al, 2019;Ghrair et al, 2020;Tran et al, 2022). Complications such as stroke (Guedeney et al, 2019), vascular injury (Abugroun et al, 2020), and hospital morbidity (Ghrair et al, 2020) were recorded.…”