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Zhang X, Geng W, Yan S, Zhang K, Liu Q, Li M. Comparison of the outcomes of concurrent versus staged TAVR combined with PCI in patients with severe aortic stenosis and coronary artery disease: a systematic review and meta-analysis. Coron Artery Dis 2024; 35:481-489. [PMID: 38682469 DOI: 10.1097/mca.0000000000001373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
BACKGROUND The optimal timing for percutaneous coronary intervention (PCI) in patients undergoing transcatheter aortic valve replacement (TAVR) remains uncertain. This research aims to evaluate the results of patients diagnosed with severe aortic valve stenosis and coronary artery disease who undergo either simultaneous or staged PCI therapy during TAVR procedures. METHODS We retrieved all relevant studies from our self-constructed databases up to January 2, 2024, encompassing databases such as Embase, Medline, Cochrane Library, and PubMed. RESULTS A total of nine studies were included, and the results showed that both surgical modalities had good safety profiles in the early and long-term stages. For early endpoint events, the risk of all-cause mortality and major bleeding within 30 years was similar in the staged TAVR + PCI and the contemporaneous TAVR + PCI ( P > 0.05). Additionally, the risk of myocardial infarction, stroke, acute kidney injury and pacemaker implantation within 30 days or perioperatively is similar ( P > 0.05). For long-term endpoint events, the risk of all-cause mortality, myocardial infarction and stroke was similar in the two groups at ≥2 years ( P > 0.05). CONCLUSION In patients undergoing TAVR who required coronary revascularization, no significant differences were observed in the early and long-term outcomes between those receiving concurrent TAVR and PCI versus staged surgery.
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Affiliation(s)
- Xiangyu Zhang
- Department of Cardiology, Baoding First Central Hospital, Baoding City, China
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Shirke MM, Wang W, Welch J, Faisal F, Nguyen D, Harky A. Staged Versus Concomitant TAVI and PCI for the Treatment of Coexisting Aortic Stenosis and Coronary Artery Disease. Cardiol Rev 2024:00045415-990000000-00264. [PMID: 38757964 DOI: 10.1097/crd.0000000000000712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Aortic stenosis (AS) is one of the most common valvular pathologies. Severe coronary artery disease (CAD) often coexists with AS. Transcatheter aortic valve implantation (TAVI) and percutaneous coronary intervention (PCI) have been established as alternatives to open surgical interventions. The data on the timing for the treatment of the 2 conditions are scarce and depend on multiple factors. This review compares the clinical outcomes of the concomitant versus staged PCI and TAVI for the treatment of AS and CAD. A systematic, electronic search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines to identify relevant articles that compared outcomes of the staged versus concomitant approaches for the TAVI and PCI. Seven studies were included involving 3745 patients. We found no statistically significant difference in primary outcomes such as 30-day mortality [odds ratio (OR) = 0.78; 95% confidence interval (CI): 0.39-1.57] and secondary outcomes including length of hospital stay (mean difference = -4.74, 95% CI: -10.96 to 1.48), new-onset renal failure (OR = 0.83, 95% CI: 0.22-3.13), cerebrovascular accidents (OR = 1.28, 95% CI: 0.64-2.57), and intraoperative blood loss (OR = 0.83, 95% CI: 0.32-2.12). New pacemaker insertion was statistically significant in favor of the concomitant approach (OR = 0.78, 95% CI: 0.63-0.96). This analysis suggests that while the 2 approaches are largely comparable in terms of most outcomes, patients at risk of requiring a pacemaker postprocedure may benefit from a concomitant approach. In conclusion, concomitant TAVI + PCI approach is nonsuperior to the staged approach for the treatment of CAD and AS. This review calls for robust trials in the field to further strengthen the evidence.
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Affiliation(s)
- Manasi Mahesh Shirke
- From the Department of Medicine, University Hospitals NHS Trust, Nottingham, United Kingdom
| | - William Wang
- Department of Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University Of London, London, United Kingdom
| | - Joseph Welch
- Department of General Surgery, Sandwell General Hospital, Sandwell and West Birmingham NHS Trust, Birmingham, United Kingdom
| | - Farqhan Faisal
- Department of Medicine, New Vision University, Tbilisi, Georgia
| | - Dang Nguyen
- Department of Cardiology, Massachusetts General Hospital, Corrigan Minehan Heart Center, Harvard Medical School, Boston, MA
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest, Liverpool, United Kingdom
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van der Harst P. Enhancing dialogue: Introducing 'Letters to the Editor'. Neth Heart J 2024; 32:147. [PMID: 38502377 PMCID: PMC10951177 DOI: 10.1007/s12471-024-01864-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 03/21/2024] Open
Affiliation(s)
- Pim van der Harst
- Department of Cardiology, Division of Heart & Lungs, University Medical Center Utrecht, Utrecht, The Netherlands.
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Aarts HM, Voskuil M, Delewi R. Reply to 'Percutaneous coronary intervention timing and coronary physiology in transcatheter aortic valve implantation patients'. Neth Heart J 2024; 32:183. [PMID: 38448647 PMCID: PMC10951139 DOI: 10.1007/s12471-024-01861-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 03/08/2024] Open
Affiliation(s)
- Hugo M Aarts
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Ronak Delewi
- Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands.
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Minten L, Bennett J, Dubois C. Percutaneous coronary intervention timing and coronary physiology in transcatheter aortic valve implantation patients. Neth Heart J 2024; 32:182. [PMID: 38441787 PMCID: PMC10951138 DOI: 10.1007/s12471-024-01860-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 03/20/2024] Open
Affiliation(s)
- Lennert Minten
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium.
| | - Johan Bennett
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Christophe Dubois
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
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Fischer J, Steffen J, Arlart T, Haum M, Gschwendtner S, Doldi PM, Rizas K, Theiss H, Braun D, Orban M, Peterß S, Hausleiter J, Massberg S, Deseive S. Concomitant percutaneous coronary intervention in patients undergoing transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2024; 103:186-193. [PMID: 38140761 DOI: 10.1002/ccd.30927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/08/2023] [Accepted: 11/24/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Patients undergoing transcatheter aortic valve implantation (TAVI) frequently have coronary artery disease requiring percutaneous coronary intervention (PCI). Usually, PCI and TAVI are performed in two separate procedures and current studies are investigating potential benefits regarding the order. However, the two interventions may also be performed simultaneously, thereby limiting the risk associated with repeated vascular access. Data evaluating benefit and harm of concomitant procedures are scarce. AIMS Therefore, this study aimed to evaluate concomitant PCI (coPCI) in TAVI patients regarding Valve Academic Research Consortium 3 (VARC-3) endpoints and long-term mortality. METHODS A total of 2233 consecutive TAVI patients from the EVERY-VALVE registry were analyzed according to the VARC-3 endpoint definitions. A total of 274 patients had undergone TAVI and concomitant PCI (coPCI group). They were compared to 226 TAVI patients who had received PCI within 60 days before TAVI in a stepwise approach (swPCI group) and to the remaining 1733 TAVI patients who had not undergone PCI recently (noPCI group). RESULTS Overall median age was 81.4 years, median Society of Thoracic Surgeons score was 4.0%. Patients in the coPCI and in the swPCI group were predominantly male with reduced left-ventricular ejection fraction. Rates of VARC-3 composite endpoints technical success and 30-day device success were comparable between all three groups. Mortality rates at 3 years after TAVI were similar (coPCI, 34.2% vs. swPCI, 31.9% vs. noPCI, 34.0% p = 0.84). CONCLUSIONS coPCI during TAVI seems comparable in a retrospective analysis. Compared to a stepwise approach, it has similar rates of composite endpoints technical success and device success as well as long-term mortality.
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Affiliation(s)
- Julius Fischer
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Julius Steffen
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
- Munich Heart Alliance, German Centre for Cardiovascular Research (DZHK), Munich, Germany
| | - Tobias Arlart
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Magda Haum
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Sarah Gschwendtner
- Zentrale Notaufnahme und Aufnahmestation, Campus Benjamin Franklin (CBF), Charité Universitätsmedizin, Berlin, Germany
| | - Philipp M Doldi
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
- Munich Heart Alliance, German Centre for Cardiovascular Research (DZHK), Munich, Germany
| | - Konstantinos Rizas
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
- Munich Heart Alliance, German Centre for Cardiovascular Research (DZHK), Munich, Germany
| | - Hans Theiss
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Martin Orban
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Sven Peterß
- Department of Heart Surgery, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
- Munich Heart Alliance, German Centre for Cardiovascular Research (DZHK), Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
- Munich Heart Alliance, German Centre for Cardiovascular Research (DZHK), Munich, Germany
| | - Simon Deseive
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
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Aarts HM, Delewi R, Claessen BE. Dealing with concomitant coronary artery disease in TAVI patients-should we treat it all in one go? Proc AMIA Symp 2023; 37:14-15. [PMID: 38174030 PMCID: PMC10761036 DOI: 10.1080/08998280.2023.2279895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 10/30/2023] [Indexed: 01/05/2024] Open
Affiliation(s)
- Hugo M. Aarts
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ronak Delewi
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Bimmer E.P.M. Claessen
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
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Delewi R, Voskuil M. The future of transcatheter aortic valve implantation is bright. Neth Heart J 2023; 31:459-460. [PMID: 37955846 PMCID: PMC10667162 DOI: 10.1007/s12471-023-01834-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 11/14/2023] Open
Affiliation(s)
- Ronak Delewi
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Michiel Voskuil
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
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