Combined Procedures of TAVI and Coronary Stenting in Patients with Aortic Stenosis and IHD

Dzhamil Asadov, David Iosseliani, Olga Zakharova, Ilya Kovalchuk, Eugene Savelov, Alexander Stepanov, Anna Rogatova, Vladislav Kriukov

Moscow City center for interventional cardioangiology, Moscow, Russia

Date, time and location: 2018.05.26 15:30, Congress Hall, 2F–A

Abstract

Objective: To study reasonability, safety and effectiveness of simultaneous TAVI and coronary stenting in elderly patients with high surgical risk.

Material and methods: In 25 (30,5%) patients TAVI and coronary stenting were performed simultaneously. Average age of patients was 77,5±3,6 years. All patients had severe aortic valve (AV) stenosis and clinical signs of exertional angina of 3rd functional class. Mean aortic transvalvular gradient was 59,6±16,1 mmHg, maximal 98,3±19,5 mmHg. The area of the AV orifice was 0,59±0,14 mm2. EuroScore - 25,3±12,4, STS - 10,1±6,6, SyntaxScore - 18,6±10,5. Most patients had at least two-vessel disease.

Results: Coronary stenting was performed during the first stage of procedure, followed by TAVI. Technical success was achieved in 100%. Mean duration of the procedure was 132,6±27,1 minutes, exposure time - 36,4±11,3 minutes. The average volume of the contrast medium used was 313,6±86,2 ml. All patients received DES, on the average - 2,1±0,8 stents per patient. Valvular prosthesis Sapien XT was used in 5 cases, CoreValve in 20. In-hospital stay was~7 days. The 30-days mortality was 0%. All patients remained clinically stable, without signs of heart failure and angina attacks. The 6-months survival was 100%. Postoperative systolic pressure gradient at the aortic valve 17,5±6,9 mm Hg, in 30 days – 19,9±8,7 mm Hg, in 6 months– 18,6±8,2 mmHg. In 14,7 ± 8,96 months the patients underwent control angiography. The rate of in-stent restenosis was 3,6%.

Conclusions: Simultaneous combined TAVI and PCI is safe and effective and do not increase the risk of complications..