Tesi etd-12222021-181854
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Tipo di tesi
Master di Secondo Livello
Autore
CERRATO, ENRICO
Indirizzo email
enrico.cerrato@gmail.com
URN
etd-12222021-181854
Titolo
Unplanned percutaneous coronary revascularization after transcatheter aortic valve replacement
Struttura
Istituto di Scienze della Vita
Corso di studi
Corsi Alta Formazione - PERCUTANEOUS INTERVENTIONAL TREATMENT OF STRUCTURAL HEART DISEASES
Commissione
relatore Dott. BERTI, SERGIO
Presidente Prof. PASSINO, CLAUDIO
Presidente Prof. PASSINO, CLAUDIO
Parole chiave
- Percutaneous coronary intervention
- transcatheter aortic valve implantation
- unplanned revascularization.
Data inizio appello
21/01/2022;
Disponibilità
completa
Riassunto analitico
OBJECTIVES This project sought to evaluate the incidence and causes of percutaneous coronary intervention (PCI) at different time periods following transcatheter aortic valve replacement (TAVR).
BACKGROUND Coronary artery disease (CAD) and aortic stenosis frequently coexist, but the optimal management of CAD following TAVR remains incompletely elucidated.
METHODS Patients undergoing unplanned PCI after TAVR were retrospectively included in an international multicenterregistry.
RESULTS Between July 2008 and March 2019, a total of 133 patients (0.9%; from a total cohort of 15,325) underwent unplanned PCI after TAVR (36.1% after balloon-expandable bioprosthesis, 63.9% after self-expandable bioprosthesis).
The median time to PCI was 191 days (interquartile range: 59 to 480 days). The daily incidence of PCI was highest duringthe first week after TAVR and then declined over time. Overall, the majority of patients underwent PCI due to an acute coronary syndrome, and specifically 32.3% had non–ST-segment elevation myocardial infarction, 15.4% had unstable
angina, 9.8% had ST-segment elevation myocardial infarction, and 2.2% had cardiac arrest. However, chronic coronary syndromes are the main indication beyond 2 years. PCI success was reported in almost all cases (96.6%), with no significant differences between patients treated with balloon-expandable and self-expandable bioprostheses (100% vs.94.9%; p =0.150).
CONCLUSIONS Unplanned PCI after TAVR is rare, with an incidence declining over time after TAVR. The mainindication to PCI is acute coronary syndrome in the first 2 years after TAVR, and thereafter chronic coronarysyndromes become prevalent. Unplanned PCIs are frequently successfully performed after TAVR, with no
apparent differences between balloon-expandable and self-expandable bioprostheses. (Revascularization After Transcatheter Aortic Valve Implantation [REVIVAL]; NCT03283501)
BACKGROUND Coronary artery disease (CAD) and aortic stenosis frequently coexist, but the optimal management of CAD following TAVR remains incompletely elucidated.
METHODS Patients undergoing unplanned PCI after TAVR were retrospectively included in an international multicenterregistry.
RESULTS Between July 2008 and March 2019, a total of 133 patients (0.9%; from a total cohort of 15,325) underwent unplanned PCI after TAVR (36.1% after balloon-expandable bioprosthesis, 63.9% after self-expandable bioprosthesis).
The median time to PCI was 191 days (interquartile range: 59 to 480 days). The daily incidence of PCI was highest duringthe first week after TAVR and then declined over time. Overall, the majority of patients underwent PCI due to an acute coronary syndrome, and specifically 32.3% had non–ST-segment elevation myocardial infarction, 15.4% had unstable
angina, 9.8% had ST-segment elevation myocardial infarction, and 2.2% had cardiac arrest. However, chronic coronary syndromes are the main indication beyond 2 years. PCI success was reported in almost all cases (96.6%), with no significant differences between patients treated with balloon-expandable and self-expandable bioprostheses (100% vs.94.9%; p =0.150).
CONCLUSIONS Unplanned PCI after TAVR is rare, with an incidence declining over time after TAVR. The mainindication to PCI is acute coronary syndrome in the first 2 years after TAVR, and thereafter chronic coronarysyndromes become prevalent. Unplanned PCIs are frequently successfully performed after TAVR, with no
apparent differences between balloon-expandable and self-expandable bioprostheses. (Revascularization After Transcatheter Aortic Valve Implantation [REVIVAL]; NCT03283501)
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