Pasic Miralem, Dreysse Stephan, Unbehaun Axel, Buz Semih, Drews Thorsten, Klein Christoph, D'Ancona Giuseppe, Hetzer Roland
German Heart Center, Berlin, Germany.
Interact Cardiovasc Thorac Surg. 2012 Apr;14(4):463-8. doi: 10.1093/icvts/ivr144. Epub 2012 Jan 9.
There is no established strategy of how and when to treat coronary artery disease (CAD) in patients referred for transcatheter aortic valve implantation (TAVI). Simultaneous, single-stage treatment of both pathologies is a possible solution. We report our initial results of simultaneously performed transapical TAVI and elective percutaneous coronary interventions (PCI) in high-risk patients with severe aortic valve stenosis. Between April 2008 and July 2011, a total of 419 patients underwent transapical TAVI. Combined elective PCI and TAVI were performed in 46 (11%) patients. Only the most significant coronary lesion or lesions were treated. Technical success of the combined approach was 100%. The mean count of implanted stents per patient was 1.6 ± 1.0 (range, 1-5 stents). The 30-day mortality rates in the PCI and TAVI group was 4.3%. Survival at 12, 24 and 36 months of the PCI and TAVI group 87.1 ± 5.5, 69.7 ± 10.3 and 69.7 ± 10.3%, respectively. The results showed that the single-stage approach with combined elective PCI and TAVI is feasible and safe. It has become our primary choice for treatment of high-risk patients with severe aortic valve stenosis and CAD.
对于接受经导管主动脉瓣植入术（TAVI）的患者，目前尚无关于如何以及何时治疗冠状动脉疾病（CAD）的确立策略。同时对两种病变进行单阶段治疗是一种可能的解决方案。我们报告了在高危重度主动脉瓣狭窄患者中同时进行经心尖TAVI和选择性经皮冠状动脉介入治疗（PCI）的初步结果。2008年4月至2011年7月，共有419例患者接受了经心尖TAVI。46例（11%）患者同时进行了选择性PCI和TAVI。仅对最严重的一处或多处冠状动脉病变进行了治疗。联合治疗方法的技术成功率为100%。每位患者植入支架的平均数量为1.6±1.0（范围为1至5个支架）。PCI和TAVI组的30天死亡率为4.3%。PCI和TAVI组在12、24和36个月时的生存率分别为87.1±5.5%、69.7±10.3%和69.7±10.3%。结果表明，选择性PCI和TAVI联合的单阶段方法是可行且安全的。它已成为我们治疗高危重度主动脉瓣狭窄和CAD患者的主要选择。
