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      Outcomes in Patients With Transcatheter Aortic Valve Replacement and Left Main Stenting : The TAVR-LM Registry

      , MD a , , MD a , , MD a , b , , MD c , , MD d , , MD a , , MBBS c , , MD d , , MD e , , MD f , , MD f , , MD g , , MD h , , MD h , , MD i , , MD j , , MS a , , MD a , , MD a , , BS a , , MS a , , MD a , , MD c , , MD k , , MD e , , MD d , , MD b , , MD f , , MD a

      Journal of the American College of Cardiology

      aortic valve stenosis, coronary artery disease, percutaneous coronary intervention, transcatheter aortic valve replacement

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          Abstract

          BACKGROUND

          A percutaneous approach with transcatheter aortic valve replacement (TAVR) and percutaneous coronary intervention (PCI) of the left main coronary artery (LM) is frequently used in high-risk patients with coexisting aortic stenosis and LM disease. Outcomes of TAVR plus LM PCI have not been previously reported.

          OBJECTIVES

          The primary objective of the TAVR-LM registry is to evaluate clinical outcomes in patients undergoing TAVR plus LM PCI.

          METHODS

          Clinical, echocardiographic, computed tomographic, and angiographic characteristics were retrospectively collected in 204 patients undergoing TAVR plus LM PCI. In total, 128 matched patient pairs were generated by performing 1:1 case-control matching between 167 patients with pre-existing LM stents undergoing TAVR and 1,188 control patients undergoing TAVR without LM revascularization.

          RESULTS

          One-year mortality (9.4% vs. 10.2%, p = 0.83) was similar between the TAVR plus LM PCI cohort and matched controls. One-year mortality after TAVR plus LM PCI was not different in patients with unprotected compared with protected LMs (7.8% vs. 8.1%, p = 0.88), those undergoing LM PCI within 3 months compared with those with LM PCI greater than 3 months before TAVR (7.4% vs. 8.6%, p = 0.61), and those with ostial versus nonostial LM stents (10.3% vs. 15.6%, p = 0.20). Unplanned LM PCI performed because of TAVR-related coronary complication, compared with planned LM PCI performed for pre-existing LM disease, resulted in increased 30-day (15.8% vs. 3.4%, p = 0.013) and 1-year (21.1% vs. 8.0%, p = 0.071) mortality.

          CONCLUSIONS

          Despite the anatomic proximity of the aortic annulus to the LM, TAVR plus LM PCI is safe and technically feasible, with short- and intermediate-term clinical outcomes comparable with those in patients undergoing TAVR alone. These results suggest that TAVR plus LM PCI is a reasonable option for patients who are at high risk for surgery.

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          Author and article information

          Journal
          8301365
          4429
          J Am Coll Cardiol
          J. Am. Coll. Cardiol.
          Journal of the American College of Cardiology
          0735-1097
          1558-3597
          27 October 2016
          1 March 2016
          01 March 2017
          : 67
          : 8
          : 951-960
          Affiliations
          [a ]Cedars-Sinai Heart Institute, Los Angeles, California
          [b ]Tel Aviv Medical Center, Tel Aviv, Israel
          [c ]Cleveland Clinic, Cleveland, Ohio
          [d ]San Raffaele Scientific Institute and EMO-GVM Centro Cuore Columbus, Milan, Italy
          [e ]Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
          [f ]Clinique Pasteur, Toulouse, France
          [g ]IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
          [h ]Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
          [i ]Hopital Privé Jacques Cartier, Massy, France
          [j ]Washington University School of Medicine, St. Louis, Missouri
          [k ]CardioVascular Center Frankfurt CVC, Frankfurt, Germany
          Author notes
          REPRINT REQUESTS AND CORRESPONDENCE: Dr. Raj R. Makkar, Heart Institute, Cedars-Sinai Medical Center, Cardiovascular Intervention Center, 8631 W. Third Street, #415-E, Los Angeles, California 90048. makkarr@ 123456cshs.org
          Article
          PMC5091082 PMC5091082 5091082 nihpa825349
          10.1016/j.jacc.2015.10.103
          5091082
          26916485
          Categories
          Article

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