Author + information
- Elena Kovaleva,
- David Iosseliani,
- Djamil Asadov,
- Igor Arabadzhyan,
- Irina Isaeva and
- Vladislav Kriukov
To evaluate the feasibility, the safety and the effectiveness of simultaneous PCI and TAVI in high surgical risk patients.
Simultaneous procedures of TAVI and PCI were performed in 20 patients. The average age of patients was 76.6 ± 3.6 years. The mean area of aortic valve orifice was 0.59 ± 0.13 mm., maximal transvalvular systolic gradient - 95.1 ± 19.5 mmHg, mean gradient - 56.7 ± 15.9 mmHg,). Six patients had single-vessel disease, the remaining patients had multivessel disease, in two case - with the lesion of the left main coronary artery. EuroScore was 25.3 ± 12.4%, STS - 17.3 ± 6.6%, Syntax score - 17.5 ± 10.5%.
The procedure was started by coronary stenting (on the average - 2.3 ± 0.8 stents per patient), followed by TAVI (CoreValve System in 15 case, Edwards Sapient XT - 5). The mean duration of the procedure was 139.5 ± 30.4 min., the average volume of contrast medium - 371.4 ± 101.4 ml., the time of scopy - 39.4 ± 10.1 min. Post-TAVI maximal transvalvular gradient was 15.4 ± 5 mmHg, mean - 7.0 ± 2.0 mmHg, regurgitation - 1.2± 0.5. In 6 months after valve implantation 85,7% had no signs of circulatory insufficiency, and 92.9% were angina-free. There were no major intra- and perioperative complications.
Transcatheter aortic valve implantation and percutaneous coronary revascularization can be successfully used for the management of patients at extremely high risk for open-heart surgery. This technique is feasible, effective and can be performed without serious complications and mortality.