26 The effects of pre-existing significant coronary artery disease upon outcome after transcatheter aortic valve implantation using the Edwards bioprosthesis

Abstract

<h3>Introduction</h3> Patients undergoing surgical aortic valve replacement (sAVR) routinely undergo simultaneous coronary artery bypass grafting (CABG) for significant coronary artery disease (CAD) due to adverse prognostic impact. While manufacturers advise percutaneous intervention (PCI) of significant CAD prior to transcatheter aortic valve implantation (TAVI) there is considerable variation among operators. <h3>Methods</h3> We performed a retrospective analysis of 168 patients who underwent TAVI using the Edwards bioprosthesis from March 2008 to October 2010 at St. Thomas Hospital, London. They were divided into two groups according to the results of the pre-TAVI coronary angiogram: (Group 1) patients with ≥1 coronary stenosis of ≥70% severity and those without (Group 2). The end-point was all-cause mortality. <h3>Results</h3> In total, 70 patients (41.7%) had significant CAD prior to TAVI, with 10 (6.0%) undergoing PCI prior to their procedure. There were no significant differences in either the baseline characteristics or access approach between the two groups (Abstract 26 tables 1 and 2). At a mean follow-up of 335±277 days (mean±SD), the overall mortality was 22.6%; Group 1 mortality was 30% and in group 2 was 17.3% (p=0.124) (see Abstract 26 figure 1) There was no difference seen in the length of stay in the intensive care unit (2.7±6.2 vs 4.1±14.9 days, p=0.462) nor in the number of days to discharge (12.6±10.1 vs 12.8±13, p=0.928). Among those patients who underwent PCI in Group 1, 8 had single vessel intervention and 2 had PCI to 2 vessels. The target vessels were left main stem (LMS) (n=2), proximal left anterior descending artery (LAD) (n=5), circumflex (n=1), right coronary artery (RCA) (n=2), saphenous vein graft (SVG) to LAD (n=1) and SVG to circumflex (n=1). Mortality in this sub-group was not significantly different from the CAD patients who did not receive PCI (50% vs 26.7%, p=0.272). <h3>Conclusion</h3> The presence of significant CAD had no significant impact upon the all-cause mortality of patients after TAVI in our study. As yet, the impact of PCI to significant CAD upon outcome after TAVI is not known and will be assessed in a prospective, randomised controlled trial currently underway.