David IosselianiSechenov First Moscow State Medical University, Russian Federation
Title: Simultaneous transfemoral endovascular procedures for aortic valve replacement (TAVI) and percutaneous coronary intervention (PCI) in old patients with concomitant aortic valve atherosclerotic stenosis (AVAS) and coronary artery disease (CAD)
Aim. To evaluate the effectiveness, the safety and the feasibility of simultaneous combined procedure of TAVI and coronary arteries stenting in elderly and old patients with AVAS and CAD at high surgical risk.
Methods and results: 173 patients were assigned to two groups: I – patients with AVAS and CAD who underwent TAVI with simultaneous stenting of the coronary arteries (n=35); II – patients with AVAS without severe stenotic changes in the coronary arteries (n=138). The patients from Group I underwent coronary arterial stenting (1,8 ± 0,8 stented vessels per patient), and then – aortic valve implantation in conformity with the standard technique. The patients from Group II underwent only TAVI. The success of procedures in both groups was 100%, there were no intra- or perioperative deaths, acute myocardial infarction, acute brain stroke, acute renal failure requiring dialysis. The groups differed in procedure duration (139,5 ± 19,4 vs. 117± 15,3 min); x-ray exposure duration (39,4 ±10,1 vs.22+7.3 min); the volume of contrast agent used (371,4 ± 89,4 vs. 316,8+ 43,4 ml). Maximal transvalvular systolic pressure gradient after the procedure, paraprosthetic regurgitation, as well as the rate of such complications as complete AV block (3,2% vs 3,9%) and left bundle branch block (25% vs. 21%) were not statistically different between the groups.
Conclusions: Combined simultaneous management of elderly and old patients with severe aortic stenosis and CAD is effective, feasible and safe. Within the first 30 days after the procedure there were no significant differences in mortality and severe complications rate between those who underwent simultaneous coronary arteries stenting and TAVI and those, in whom were performed TAVI only.
Prof. David Iosseliani, Academician of Russian Academy of Sciences FACC, FESC, is one of the most renowned Russian interventional cardiologists and of the pioneers of this discipline in Russia. He is Head of the Chair of Interventional Cardioangiology at Sechenov Medical University and President of the Center of Interventional Cardioangiology in Moscow, Russia. He is the author of over 450 publications, several monographs and book chapters, several Patents. He attended numerous International Conferences and Congresses as moderator, lecturer and member of the organizing committees. He is the founder and (at present) first Vice-President of Russian Society of Interventional Cardioangiology, Editor-in-Chief of “International Journal of interventional Cardioangiology” and member of the Editorial Boards of several medical journals.