Dzhamil AsadovSechenov University, Russian Federation
Title: Simultaneous Transfemoral Endovascular Procedures for Aortic Valve Replacement (TAVI) and Percutaneous Coronary Intervention (PCI) in Old Patients with Aortic Valve Atherosclerotic Stenosis (AVAS) and Coronary Artery Disease (CAD)
Over half of patients with atherosclerotic aortic valve stenosis have coronary disease. Up to now, open-heart surgery has been considered a “gold standard” for the treatment of such patients. However, a significant part of these patients, especially old patients, are at great risk for surgical and post-surgical complications, and some of them have contraindications for operations with extracorporeal circulation. In such cases one of the options is to perform simultaneous transcatheter aortic valve replacement (TAVI) and coronary stenting (CS).
Aim: To evaluate the effectiveness, the safety and the feasibility of simultaneous combined procedure of TAVI and ?S in old patients with AVAS and CAD at high surgical risk.
Methods: The study comprised 35 patients with AVAS and CAD who underwent TAVI with simultaneous CS. The in-hospital period and the mid-term results (6 months) were studied.
Results: The success of combined simultaneous TAVI and PCI was 100%. There were no intra- or perioperative deaths, acute myocardial infarction, major bleedings or acute renal failure requiring dialysis. There was 1 patient with acute brain stroke and one case of hemotamponade. Among the complications seen during the procedures one has to note the left bundle branch block and other rhythm disturbances in 25,7% and regurgitation (leakage) on the aortic valve in 6,6% of cases. During the 6-month follow-up one patient died from cancer. Progressive stenotic atherosclerosis of native coronary arteries revealed by selective coronary angiography was found in one patient.
Conclusions: Combined simultaneous management of elderly and old patients with severe aortic stenosis and CAD is feasible and safe. Within the first 30 days after the procedure there were no significant differences in mortality and severe complications rate compared with the patients, who underwent only TAVI in our Center.
To be updated