Outcomes in Patients With Transcatheter Aortic Valve Replacement and Left Main Stenting: The TAVR-LM Registry

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• 作者：Tarun Chakravarty ; MD<sup>asup> ; Rahul Sharma ; MD<sup>asup> ; Yigal Abramowitz ; MD<sup>asup><sup> ; sup><sup>bsup> ; Samir Kapadia ; MD<sup>csup> ; Azeem Latib ; MD<sup>dsup> ; Hasan Jilaihawi ; MD<sup>asup> ; Kanhaiya Lal Poddar ; MBBS<sup>csup> ; Gennaro Giustino ; MD<sup>dsup> ; Henrique B. Ribeiro ; MD<sup>esup> ; Didier Tchetche ; MD<sup>fsup> ; Benoit Monteil ; MD<sup>fsup> ; Luca Testa ; MD<sup>gsup> ; Giuseppe Tarantini ; MD<sup>hsup> ; Michela Facchin ; MD<sup>hsup> ; Thierry Lefè ; vre ; MD<sup>isup> ; Brian R. Lindman ; MD<sup>jsup> ; Babak Hariri ; MS<sup>asup> ; Jigar Patel ; MD<sup>asup> ; Nobuyuki Takahashi ; MD<sup>asup> ; George Matar ; BS<sup>asup> ; James Mirocha ; MS<sup>asup> ; Wen Cheng ; MD<sup>asup> ; Murat E. Tuzcu ; MD<sup>csup> ; Horst Sievert ; MD<sup>ksup> ; Josep Rodé ; s-Cabau ; MD<sup>esup> ; Antonio Colombo ; MD<sup>dsup> ; Ariel Finkelstein ; MD<sup>bsup> ; Jean Fajadet ; MD<sup>fsup> ; Raj R. Makkar ; MD<sup>asup><sup> ; sup><sup>makkarr@cshs.org" class="auth_mail" title="E-mail the corresponding authorsup>
• 关键词：aortic valve stenosis ; coronary artery disease ; percutaneous coronary intervention ; transcatheter aortic valve replacement
• 刊名：Journal of the American College of Cardiology
• 出版年：2016
• 出版时间：1 March 2016
• 年：2016
• 卷：67
• 期：8
• 页码：951-960
• 全文大小：520 K

文摘

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.

sSec_2">Objectives

spara0015">The primary objective of the TAVR-LM registry is to evaluate clinical outcomes in patients undergoing TAVR plus LM PCI.

sSec_3">Methods

spara0020">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.

sSec_4">Results

spara0025">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.

sSec_5">Conclusions

spara0030">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.