TAVR plus left main PCI was associated with similar 1-year mortality compared to TAVR without left main revascularization (9.4% vs. 10.2%, p=0.83).
Case-Control (n=256)
Does TAVR plus LM PCI result in similar mortality compared to TAVR alone in patients with aortic stenosis?
TAVR combined with left main PCI is safe and feasible, yielding 1-year mortality rates comparable to TAVR alone in matched patients.
Absolute Event Rate: 9.4% vs 10.2%
p-value: p=0.83
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.
““Despite the anatomic proximity of the aortic valve annulus to the ostium of the [left main], patients with symptomatic, severe [aortic stenosis], and [left main] disease who are poor candidates for an open surgical approach can be successfully managed with TAVR, even in the presence of ostial le...”
Chakravarty et al. (Mon,) conducted a case-control in Coexisting aortic stenosis and left main coronary artery disease (n=256). TAVR plus left main PCI vs. TAVR without left main revascularization was evaluated on 1-year mortality (p=0.83). TAVR plus left main PCI was associated with similar 1-year mortality compared to TAVR without left main revascularization (9.4% vs. 10.2%, p=0.83).