Department of Cardiovascular Surgery, University Heart Center Hamburg, Martinistrasse 52, Hamburg, Germany.
Clin Res Cardiol. 2011 Apr;100(4):311-6. doi: 10.1007/s00392-010-0243-6. Epub 2010 Oct 21.
We investigated our experience with combined transcatheter aortic valve implantation (TAVI) and percutaneous coronary intervention (PCI) as an alternative strategy in high-risk patients.
Combined surgical aortic valve replacement and coronary artery bypass grafting are the gold standard treatment for patients with aortic stenosis and concomitant coronary artery disease. However, a substantial share of patients is unfit for surgery due to contraindications.
Twenty-eight patients (15 female) underwent combined TAVI and PCI after being refused for surgery. In 21 patients (group 1) a staged approach of PCI prior to subsequent TAVI was chosen. Seven patients (group 2) were treated in a single-stage procedure.
Mean patient age was 80.1 ± 6.9 years, pre-procedural risk assessment revealed a mean logEuroSCORE of 26.8 ± 13.4%. Left ventricular ejection fraction was 45.6 ± 11.1%. Baseline mean/peak transvalvular gradients were 40.2 ± 16.8 and 65.6 ± 26.6 mmHg, respectively, and decreased to mean/peak values of 9.3 ± 4.2/15.2 ± 8.4 mmHg (p < 0.0001), effective orifice area increased from 0.73 ± 0.25 to 1.74 ± 0.47 cm(2) (p < 0.0001). In group 2, fluoroscopy time and amount of contrast agent were significantly higher compared to group 1 (18.1 ± 9.2 vs. 9.5 ± 7.0 min; p = 0.03/292.3 ± 117.5 vs. 171.9 ± 68.4 ml; p = 0.006). In group 1, patients received PCI 14.3 ± 9.6 days prior to TAVI. In group 2, PCI was performed immediately before TAVI. A mean of 1.6 ± 1.0 stents was placed per patient. No periprocedural myocardial infarction or stroke occurred in any patient. Thirty-day mortality was 7.1% (2/28).
Our strategy of staged or single-stage TAVI and PCI proved feasible and safe in this high-risk patient population. Whether there is advantage of one approach over the other remains to be elucidated.
我们研究了在高危患者中作为替代策略的经导管主动脉瓣植入术（TAVI）联合经皮冠状动脉介入治疗（PCI）的经验。
主动脉瓣狭窄合并冠状动脉疾病患者的金标准治疗是联合外科主动脉瓣置换和冠状动脉旁路移植术。然而，由于存在禁忌症，相当一部分患者不适合手术。
28 名患者（15 名女性）因手术禁忌而被拒绝后接受了 TAVI 和 PCI 的联合治疗。在 21 名患者（组 1）中，选择了 PCI 的分期方法，随后进行 TAVI。7 名患者（组 2）接受了单阶段治疗。
患者平均年龄为 80.1±6.9 岁，术前风险评估显示平均 logEuroSCORE 为 26.8±13.4%。左心室射血分数为 45.6±11.1%。基线平均/峰值跨瓣梯度分别为 40.2±16.8 和 65.6±26.6mmHg，并分别降低至 9.3±4.2/15.2±8.4mmHg（p<0.0001），有效瓣口面积从 0.73±0.25 增加至 1.74±0.47cm2（p<0.0001）。在组 2 中，与组 1 相比，透视时间和造影剂用量明显更高（18.1±9.2 比 9.5±7.0 分钟；p=0.03/292.3±117.5 比 171.9±68.4ml；p=0.006）。在组 1 中，患者在 TAVI 前 14.3±9.6 天接受 PCI。在组 2 中，PCI 立即在 TAVI 之前进行。每位患者平均放置 1.6±1.0 个支架。没有患者发生围手术期心肌梗死或卒中。30 天死亡率为 7.1%（2/28）。
在高危患者人群中，分期或单阶段 TAVI 和 PCI 的策略是可行且安全的。哪种方法更有优势仍有待阐明。
