title: Transcatheter aortic valve implantation combined with elective coronary artery stenting: a simultaneous approach†.
abstract: OBJECTIVE
  Many patients referred for transcatheter aortic valve implantation (TAVI) also require percutaneous coronary intervention (PCI). The aim of the study was to identify whether combined treatment of patients with aortic stenosis and coronary artery disease (CAD) with TAVI and PCI has comparable results to treatment of patients with no CAD or with CAD with non-significant lesions who receive only TAVI.
  
  
  METHODS
  Between April 2008 and August 2013, 730 consecutive patients underwent transapical TAVI at our institution. In our study population of 593 patients, 285 (48.1%) had no CAD and received TAVI only (Group I); 232 (39.1%) presented with CAD but no highly significant coronary artery lesion(s) and also received TAVI only (Group II), and 76 (12.8%) had CAD and highly significant coronary lesion(s) and underwent combined, single-staged TAVI and PCI (Group III). Three transapical TAVI patients who received PCI because of iatrogenic coronary artery obstruction during TAVI and 134 transapical TAVI patients with previous CABG were excluded from this study.
  
  
  RESULTS
  Group II showed a calculated mean SYNTAX score of 5.7 ± 7.4. However, Group III showed a statistically significantly higher mean SYNTAX score of 8.0 ± 5.7 than Group II (P < 0.001) before the combined procedure. Combined TAVI and PCI reduced the mean SYNTAX score significantly from 8.0 ± 5.7 to 3.0 ± 4.9 (P < 0.001) in those patients presenting with severe aortic stenosis and highly significant CAD (Group III). The thirty-day all-cause mortality rate was 5.3, 3.9 and 2.6% for Group I, II and III, respectively (P = 0.609). Patients with highly significant CAD undergoing TAVI and PCI had similar survival up to 3 years as patients without CAD undergoing TAVI only. Radiation time and amount of contrast agent were higher during combined treatment in Group III (P < 0.05). However, no difference in acute kidney injury post-procedurally was observed.
  
  
  CONCLUSIONS
  Single-stage combined treatment of severe aortic stenosis and highly relevant coronary lesions is a safe and feasible procedure. Early survival and survival up to 3 years are comparable to that observed in patients presenting without CAD who received TAVI only. PCI effectively reduces the complexity of coronary lesions. Although more contrast agent is applied during the combined treatment, the rate of acute kidney injury was not higher.
authors.affiliation: Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Adam
authors.initials: A
authors.lastname: Penkalla
authors.affiliation: Deutsches Herzzentrum Berlin, Berlin, Germany pasic@dhzb.de.
authors.forename: Miralem
authors.initials: M
authors.lastname: Pasic
authors.affiliation: Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Drews
authors.affiliation: Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Semih
authors.initials: S
authors.lastname: Buz
authors.affiliation: Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Dreysse
authors.affiliation: Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Marian
authors.initials: M
authors.lastname: Kukucka
authors.affiliation: Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Mladenow
authors.affiliation: Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Hetzer
authors.affiliation: Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Unbehaun
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery; D003324:Coronary Artery Disease / Q000601:surgery; D003331:Coronary Vessels / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D015607:Stents; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000379:methods* / Q000401:mortality
keywords: Aortic valve stenosis; Coronary artery disease; Percutaneous coronary intervention; Transcatheter aortic valve implantation