Outcome of patients with severe aortic stenosis undergoing ad hoc transcatheter aortic valve implantation without invasive pre-evaluation

Summary Aims: To investigate the feasibility and safety of TAVI without prior invasive assessment. Methods and Results: A total of 489 patients underwent TAVI for treatment of severe aortic stenosis between July 2007 and April 2012 and were included in a prospective single-centre registry. Of 437 patients (90%), pre-procedural evaluation included right and left heart catheterisation, whereas 49 patients (10%) were scheduled to undergo TAVI without prior invasive assessment. Among patients without invasive assess ment, coronary angiography was performed immediately before TAVI within the same intervention. Baseline patient characteristics and calculated risk scores were comparable between groups. Coronary artery disease was detected in 64% and 49% of patients with and without invasive assessment, respectively (p = 0.06), and resulted in more frequent use of concomitant percutaneous coronary intervention among patients without invasive a ssessment (15% vs 27%, p = 0.04). Clinical outcome at 30 days revealed no significant differences between patients with and without invasive assessment in terms of all-cause mortality (6.0% vs 4.1%, HR 1.40, 95% CI 0.33–5.92, p = 0.65), myocardial infarction (0.5% vs. 0%, p = 1.00), and major stroke (2.6% vs. 4.2%, HR 0.61, 95% CI 0.14–2.75, p = 0.52). Major bleeding was more frequent among patients undergoing invasive assessment as compared to those without invasive assessment (28.9% vs. 14.3%, RR 2.02, 95% CI 1.00–4.07, p = 0.05). Conclusions: In selected patients, TAVI without prior invasive assessment may r esult in similar risk of ischaemic events compared to TAVI among patients with invasive assessment despite the more frequent use of concomitant PCI.