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Do the patients with coronary artery disease have the same benefits from transcatheter aortic valve implantation?

Session Poster Session 1

Speaker Paulo Maia Araujo

Event : Heart Failure 2018

  • Topic : valvular, myocardial, pericardial, pulmonary, congenital heart disease
  • Sub-topic : Valvular Heart Disease – Treatment
  • Session type : Poster Session

Authors : PM Araujo (Porto,PT), A Nunes (Porto,PT), S Torres (Porto,PT), M Braga (Porto,PT), R Pinto (Porto,PT), J Rodrigues (Porto,PT), RA Rodrigues (Porto,PT), PB Almeida (Porto,PT), MB Campelo (Porto,PT), JC Silva (Porto,PT), MJ Maciel (Porto,PT)

Authors:
PM Araujo1 , A Nunes1 , S Torres1 , M Braga1 , R Pinto1 , J Rodrigues1 , RA Rodrigues1 , PB Almeida1 , MB Campelo1 , JC Silva1 , MJ Maciel1 , 1Sao Joao Hospital, Cardiology - Porto - Portugal ,

Citation:

Introduction: Transcatheter aortic valve implantation (TAVI) is an effective treatment for symptomatic severe aortic stenosis, considered at high surgical risk. Coronary artery disease (CAD) is a frequent comorbidity in these patients (pts) and can influence the results of this procedure.

Purpose: To evaluate if the beneficial effects of TAVI on morbi/mortality and on the symptoms improvement are comparable in patients with or without CAD.

Methods: We retrospectively evaluated pts submitted to TAVI in our hospital between October 2014 and December 2016. All pts had symptomatic severe aortic stenosis prior to the procedure and the decision for referral for TAVI was made by a multidisciplinary Heart Team. CAD was defined as the presence of obstructive lesions (any stenosis =70% or left main [LM] stenosis =50%).

Results: During this period, 89 pts were submitted to TAVI, with a mean age of 80.2±7.1 years, of whom 51.7% (n=46) were female. Forty two pts (47.2%) had CAD: one vessel in 19.1%; 2 vessels in 4.5%; 3 vessels in 5.6%; involvement of LM in 33%. Of this group, 47.6% had been previously submitted to PCI and 35.7% to CABG. Additionally, in fifteen pts (35.7% of CAD group) periprocedural PCI was performed.
Baseline characteristics weren’t significantly different between pts with/wihout CAD regarding to age (81.1 vs 79.5 years; p=0.69), sex (45.2% vs 57.4% female; p=0.25), left ventricular ejection fraction (55.0% vs 50.7%; p=0.66), NYHA class =2 (97.6% vs 100%; p=0.29) or presence of angina (26.2% vs 14.9%; p=0.19). As expected, EuroScore II was higher in CAD pts (7.8% vs 3.8%; p<0.01).
Incidence of intra/postprocedural complications was similar between CAD pts vs no CAD: 64.3% vs 68.1% (p= 0.71). However, mean stay was higher in CAD pts (15.3 vs 12.4 days; p= 0.01). Only one patient had in-hospital mortality (no CAD).
During a mean time of follow-up of 386±93 days after discharge, CAD pts had similar rates of all-causes mortality (9.8% vs 4.3%, p=0.32), but cardiovascular mortality was tendentially higher (7.3% vs 0%), although not reaching statistical significance (p=0.06).
CAD group had higher rates of hospitalizations: 39.0% vs 19.6% (p=0.05).
At one year after discharge, in the CAD group, TAVI resulted in a significant reduction of angina (pre-TAVI: 26.2% vs post-TAVI 5.7%; p<0.01) and of NYHA class =2 (pre-TAVI: 97.6% vs post-TAVI 37.1%; p<0.01). The proportion of pts reporting an overall improvement on functional capacity after the procedure was high, with similar rates between pts with or without CAD: 85.7% vs 76.7% (p=0.32).

Conclusion: In this population, the presence of CAD was associated with higher morbidity and a tendency to higher cardiovascular mortality after TAVI. However, this procedure successfully improved symptoms and functional capacity in CAD group,  similarly to the other pts. Therefore, TAVI has important clinical benefits even in pts with CAD.

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