Eastern Cardiothoracic Surgical Society

Role of Coronary Artery Disease in Clinical Outcomes Following Trans-catheter Aortic Valve  Replacement
Mark A. Groh1, Ivan Diaz2, William B. Abernethy3, Joshua P. Leitner 3, Gerard L. Champsaur4,  1Asheville Heart, Asheville, NC, 2Cornell University, New York, NY, 3Asheville Cardiology
Associates, Asheville, NC, 4 Mission Hospital Asheville, NC

OBJECTIVE: Coronary artery disease (CAD) is present in up to 50% of patients with symptomatic aortic stenosis (AS). We assessed the impact of CAD on outcomes of patients undergoing Trans-catheter aortic valve replacement (TAVR) for AS.

METHODS: A series of 176 consecutive patients with AS receiving a TAVR from Jan 2012 to December 2015 were reviewed retrospectively. CAD was documented in 96 of them (Group I, 54.5%) by prior myocardial infarction (MI), coronary bypass intervention (CABG) or percutaneous coronary intervention (PCI), or presence of significant stenosis of main or proximal left anterior descending arteries. The 80 remaining patients (Group II, 45.5%) were considered free of CAD.

RESULTS: Group I had a higher number of male patients, markers of CAD, hypertension, higher STS PROM score (Table SA13-1) and number of previous cardiac procedures. PCI was performed in 23 (39%) within 30 days of TAVR, with no differences in history or symptoms with patients receiving PCI in more than 30 days of TAVR (n= 36). Early morbidity was represented by 5 strokes and one TIA in Group I and 3 strokes and 2 TIA in Group II. Early pre-discharge mortality was 7% and 3% in groups I and II, with an additional 30-day mortality of 2% and 3%, respectively.

CONCLUSIONS: Despite a higher STS risk score, patients with AS and CAD can be offered TAVR with a mortality risk equivalent to that of non-CAD patients as long as the ischemic burden is determined to be minimal or alleviated by an additional, immediately pre-TAVR PCI.

Table SA13-1:  Baseline characteristics in CAD and non-CAD groups. Data in mean ± SD or n (%)

Variable       CAD, n= 96           Non-CAD, n= 80 p value
Age, years 84.10 ± 10.29   83.83 ± 7.37 0.818
Gender, male 60 (62.50) 29 (36.25) 0.0005
Prior PCI 59 (61.45) 0 (0) <0.001
Prior CABG 42 (43.75) 0 (0) <0.001
Prior TIA 25 (4.03) 25 (5.31) 0.889
Prior stroke 10 (10.41) 9 (11.25) 0.879
STS PROM 8.00 ± 3.50 6.84 ± 3.09 0.0224
Discharge mortality 7 (7.29) 3 (3.75) 0.315
30-day mortality 2 (2.08) 3 (3.75) 0.511