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Unplanned percutaneous coronary intervention after transcatheter aortic valve replacement
Session:
Posters (Sessão 4 - Écran 6) - Intervenção Valvular Aórtica Percutânea 1
Speaker:
Mariana Lima
Congress:
CPC 2023
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.4 Valvular Heart Disease – Treatment
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Mariana Lima; Elisabete Jorge; Ana Vera Marinho; João Rosa; Rita Gomes; Gustavo Campos; Luís Leite; Joana Silva; Marco Costa; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Background:</span></strong><span style="font-family:"Arial",sans-serif"> Coronary artery disease (CAD) and aortic valve stenosis (AS) frequently coexist. This association is the result of similar pathogenesis and risk factors. Coronary access after transcatheter aortic valve replacement (TAVR) can make percutaneous coronary intervention (PCI) challenging. We aimed to evaluate the incidence and characteristics of unplanned PCI after TAVR.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Methods: </span></strong><span style="font-family:"Arial",sans-serif">In a single-center study, TAVR candidates were systematically screened for concomitant CAD using coronary angiography before TAVR. The decision for performing PCI was left to the Heart Team, considering the myocardium at risk, lesion complexity, and symptom status. We compiled a database of baseline characteristics, procedures, and follow-up data. Regular clinical FU was scheduled at 30 days and 1 year. We analyze the rate of unplanned PCI during the first year after TAVR.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Results:</span></strong><span style="font-family:"Arial",sans-serif"> We studied 205 patients undergoing TAVR between 10 March 2020 and 10 December 2021. 55,6% were women with a mean age of 81,4 years (±6,3). Regarding the classic risk factors, 30,3% were diabetic, 71,6% had dyslipidemia, 78,6% had hypertension and 10% were active smokers. When it comes to prior history of CAD, 32,5% of patients had a history of PCI, 5% of CABG, and 11,5% of acute coronary syndrome (ACS). Atrial fibrillation was present in 35,7% of patients and peripheral arterial disease in 23,5%. The mean left ventricular ejection fraction was 52% (±11,4), the mean transaortic gradient was 48,5 mmHg (±14,5%) and the mean NT-proBNP was 5456,9 pg/mL (±10895,8). In terms of the type of transcatheter aortic valve, we implanted 25 balloon-expandable and 175 self-expandable aortic valves. During the FU, only 2 patients underwent unplanned PCI after TAVR (0,98%). The indication for unplanned PCI was ACS. Both patients had a prior history of CAD. One patient was admitted due to non-ST elevation ACS Killip Kimball score 2, 15 days after TAVR, caused by severe in-stent restenosis in the right coronary artery (PCI in March 2020) and severe stenosis in the left anterior descending artery. Successful PCI was performed in both lesions using the left radial artery. The second patient had a lateral ST elevation ACS 13 months after TAVR and was submitted to successful PCI of the first diagonal by right radial access.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Conclusions:</span></strong><span style="font-family:"Arial",sans-serif"> Unplanned PCI after TAVR was infrequent and the most common indication for PCI was ACS.</span></span></span></p>
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