title: Safety and effectiveness of a selective strategy for coronary artery revascularization before transcatheter aortic valve implantation.
abstract: OBJECTIVE
  We assessed the safety and effectiveness of a selective percutaneous revascularization strategy before TAVI in a single-center prospective registry.
  
  
  BACKGROUND
  Management of Coronary Artery Disease (CAD) before Transcatheter Aortic Valve Implantation (TAVI) is not yet established.
  
  
  METHODS
  Percutaneous Coronary Intervention (PCI) was scheduled in proximal-to-mid coronary segment lesions on major coronary branches. TAVI was performed by percutaneous trans-femoral, trans-subclavian or trans-apical approach, using either the self-expandable III generation CoreValve (Medtronic, Minneapolis, Minnesota USA) or the Edwards SAPIEN(™) /SAPIEN XT balloon-expandable prosthesis (Edwards Lifesciences Irvine, CA). Clinical and echocardiographic follow-up was collected at 30-day, 3,6,12-month and yearly thereafter.
  
  
  RESULTS
  Out of 191 patients who underwent TAVI, 113 (59.2%) had CAD. Mean age was 80.5 ± 6.9 years (57.6% female), logistic EuroSCORE was 21.4% ± 13.4. Twenty-seven (14.1%) patients had previous percutaneous and 29 (15.2%) surgical revascularization. PCI was performed as scheduled before TAVI in 39 (20.4%) patients, without adverse events. Complete anatomical revascularization was obtained in 38 of 113 CAD patients (33.6%). After TAVI, 30-day mortality was 4.2%, and was comparable between CAD and no-CAD patients (P = ns), while 30-day myocardial infarction incidence was 2.6% and occurred only in the CAD group (4.4%, P = 0.06). Overall mortality at follow-up (12.9 ± 9.5 months) was 14.8%, without difference between groups (P = 0.88). At follow-up, five patients underwent coronary revascularization.
  
  
  CONCLUSIONS
  In this study, the incidence of CAD is high in patients referred for TAVI. A selective, clinical based, coronary revascularization before TAVI seemed to be safe, and was associated with an outcome similar to those observed in no-CAD TAVI patients.
authors.affiliation: Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy. gasparetto.valeria@gmail.com
authors.forename: Valeria
authors.initials: V
authors.lastname: Gasparetto
authors.forename: Chiara
authors.initials: C
authors.lastname: Fraccaro
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
authors.forename: Paolo
authors.initials: P
authors.lastname: Buja
authors.forename: Augusto
authors.initials: A
authors.lastname: D'Onofrio
authors.forename: Ermela
authors.initials: E
authors.lastname: Yzeiraj
authors.forename: Demetrio
authors.initials: D
authors.lastname: Pittarello
authors.forename: Giambattista
authors.initials: G
authors.lastname: Isabella
authors.forename: Gino
authors.initials: G
authors.lastname: Gerosa
authors.forename: Sabino
authors.initials: S
authors.lastname: Iliceto
authors.forename: Massimo
authors.initials: M
authors.lastname: Napodano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000401:mortality / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D016009:Chi-Square Distribution; D023921:Coronary Stenosis / Q000150:complications / Q000401:mortality / Q000628:therapy*; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D011446:Prospective Studies; D011474:Prosthesis Design; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome