Interventional treatment in elderly patients with severe aortic valve stenosis and coronary artery disease

Aortic stenosis (AS) is a valvular heart disease commonly found in the elderly patients and frequently is associated with coronary artery disease (CAD). The impact of CAD severity and of the percutaneous coronary intervention (PCI) on post-TAVI outcomes is frequently debated. Purpose. Comparison of clinical and hemodynamic outcomes, as well as the rate of major adverse cardiovascular and cerebrovascular events (MACE) in patients undergoing TAVI with PCI (patients with AS and CAD) versus isolated TAVI (patients with AS). Material and methods. Our team conducted a prospective study that included 41 patients, with an age greater than 70 years old, who were diagnosed with severe aortic valve stenosis. After performing coronary angiography, the patients were divided into two groups: 32 patients without significant coronary lesions and 9 patients with multivessel lesions with a Syntax Score <22 and who subsequently underwent coronary angioplasty (PCI). Results. The TAVI procedure was performed with a 100% success rate. After the procedure, the ejection fraction increased inconsiderably in all patients, but the average pressure gradient decreased impressively, the average value being12.59 ± 5.62 mmHg vs 14.78 ± 8.73 mmHg, p< 0.001. The peak velocity of the jet through the aortic valve is 2.36 ± 0.50 m/s vs 2.53 ± 0.83 m/s, p< 0.001.Conclusion. The one-year post-procedural follow-up showed that both groups of patients had a similar rate of MACE, with a significant improvement in clinical-hemodynamic parameters according to transthoracic echocardiography data.