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^a ; Rahul Sharma ; MD^a ; Yigal Abramowitz ; MD^a ; ^b ; Samir Kapadia ; MD^c ; Azeem Latib ; MD^d ; Hasan Jilaihawi ; MD^a ; Kanhaiya Lal Poddar ; MBBS^c ; Gennaro Giustino ; MD^d ; Henrique B. Ribeiro ; MD^e ; Didier Tchetche ; MD^f ; Benoit Monteil ; MD^f ; Luca Testa ; MD^g ; Giuseppe Tarantini ; MD^h ; Michela Facchin ; MD^h ; Thierry Lefè ; vre ; MDⁱ ; Brian R. Lindman ; MD^j ; Babak Hariri ; MS^a ; Jigar Patel ; MD^a ; Nobuyuki Takahashi ; MD^a ; George Matar ; BS^a ; James Mirocha ; MS^a ; Wen Cheng ; MD^a ; Murat E. Tuzcu ; MD^c ; Horst Sievert ; MD^k ; Josep Rodé ; s-Cabau ; MD^e ; Antonio Colombo ; MD^d ; Ariel Finkelstein ; MD^b ; Jean Fajadet ; MD^f ; Raj R. Makkar ; MD^a ; ^{makkarr@cshs.org" class="auth_mail" title="E-mail the corresponding author}
• 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.

Objectives

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

Methods

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.

Results

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.

Conclusions

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.