Meta-analysis comparing outcomes in patients undergoing transcatheter aortic valve implantation with versus without percutaneous coronary intervention.
Humans; Treatment Outcome; Severity of Illness Index; Echocardiography; Coronary Angiography; Aortic Valve Stenosis/complications/diagnosis/surgery; Coronary Artery Disease/complications/diagnosis/surgery; Percutaneous Coronary Intervention/methods; Transcatheter Aortic Valve Replacement/methods
Patients having transcatheter aortic valve implantation (TAVI) routinely undergo coronary angiography before the procedure to define the coronary anatomy and to evaluate the extend of coronary artery disease (CAD). Whether percutaneous coronary intervention (PCI) prior/concomitant with TAVI confers any additional clinical benefit in patients with CAD remains unclear. Literature search was performed using Medline, Embase, Google Scholar, and Scopus from inception of these databases till April 2019. Included outcomes were 30-day all-cause mortality, stroke, myocardial infarction (MI), acute kidney injury, and 1-year mortality. The main summary estimate was random effects odds ratio (OR) with 95% confidence intervals (CIs). Eleven cohort studies enrolling 5,580 patients (mean age 82.4 years and 52.6% females) were included. Our study found no difference in effect estimates for 30-day all-cause mortality (OR 1.30 [0.85 to 1.98], p = 0.22, I(2) = 37.5%), stroke (OR 0.7 (0.36 to 1.45), p = 0.36, I(2) = 32.8%), MI (OR 2.71 [0.55 to 12.23], p = 0.22, I(2) = 41.3%), acute kidney injury (OR 0.7 [0.46 to 1.06], p = 0.08, I(2) = 14.4%) and 1-year all-cause mortality (OR 1.19 [0.92 to 1.52], p = 0.18, I(2) = 0.0%) in patients who underwent TAVI with and without PCI. In conclusion, our analysis indicates that PCI with TAVI in patients with severe aortic stenosis and concomitant CAD grants no additional clinical advantage in terms of patient important clinical outcomes. Further randomized studies are needed to better delineate the clinical practice for myocardial revascularization in patients receiving transcatheter therapy for aortic valve disease.
Lateef N; Khan MS; Deo VS; Yamani N; Riaz H; Virk HUH; Khan SU; Hedrick DP; Kanaan A; Reed GW; Krishnaswamy A; Puri R; Kapadia SR; Kalra A
The American journal of cardiology
2019
2019-12-01
Copyright © 2019 Elsevier Inc. All rights reserved.
journalArticle
<a href="http://doi.org/10.1016/j.amjcard.2019.08.024" target="_blank" rel="noreferrer noopener">10.1016/j.amjcard.2019.08.024</a>
PMID: 31575422
Short-term and long-term outcomes of patients undergoing urgent transcatheter aortic valve replacement under a minimalist strategy.
Female; Humans; Male; Retrospective Studies; Treatment Outcome; Risk Factors; United States/epidemiology; Follow-Up Studies; Severity of Illness Index; Time Factors; Aged 80 and over; Length of Stay; transcatheter aortic valve replacement; Transcatheter Aortic Valve Replacement/methods; minimalist approach; Hospital Mortality/trends; severe aortic stenosis; urgent procedure; Aortic Valve Stenosis/diagnosis/mortality/surgery; Aortic Valve/diagnostic imaging/surgery; Cardiac Catheterization/methods; Echocardiography Transesophageal; Elective Surgical Procedures/methods; Femoral Artery
OBJECTIVES: Urgent transcatheter aortic valve replacement (TAVR) is associated with worse short-term outcomes compared with elective TAVR; however, little is known about long-term outcomes or the safety of the minimalist strategy in this setting. This study investigated the short-term and long-term outcomes of urgent TAVR compared with elective TAVR under a minimalist strategy (transfemoral [TF] approach with conscious sedation and no transesophageal echocardiography guidance). METHODS: After excluding 2 emergent patients requiring immediate procedures, a total of 474 consecutive patients underwent elective TF-TAVR (396 patients; 83.6%) or urgent
Ichibori Y; Li J; Patel T; Lipinski J; Ladas T; Saric P; Kobe D; Tsushima T; Peters M; Patel S; Davis A; Markowitz AH; Bezerra HG; Costa MA; Kalra A; Attizzani GF
The Journal of invasive cardiology
2019
2019-02
Copyright © 2019 Elsevier Inc. All rights reserved.
journalArticle
<a href="http://doi.org/" target="_blank" rel="noreferrer noopener"></a>
PMID: 30700628