Study Shows Complete Revascularization May Not Be Essential for Success of TAVR

Revascularization, whether complete or incomplete, following a transcatheter aortic valve replacement (TAVR) procedure did not make a difference in clinical outcomes in elderly patients as long as the revascularization treatment strategy was based on a consensus opinion of a heart team, according to a study published in JACC: Cardiovascular Interventions.

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Investigators at Erasmus Medical Center in Rotterdam, the Netherlands, evaluated 263 patients at a mean age of 80 years who underwent TAVR from 2005 to 2012 and were followed for 16 months afterward for the presence of coronary artery disease. A dedicated heart team, comprised of at least one interventional cardiologist, one cardiac surgeon, and one imaging specialist, along with an anesthesiologist, geriatrician, or neurologist when indicated, determined the treatment strategy and completeness of revascularization. There were three revascularization options: staged percutaneous coronary intervention (PCI) before the TAVR procedure, PCI given concomitantly with TAVR, and no PCI given at all.

The researchers found no significant differences among the three treatment groups in overall survival and other clinical endpoints, whether patients had complete or incomplete revascularization. Overall, 37 percent of the patients had incomplete revascularization after a TAVR procedure. The one-year mortality rate for patients with complete revascularization was 79.9 percent versus 77.4 percent for patients with incomplete revascularization (p = 0.85).

The investigators concluded that in elderly patients undergoing TAVR for severe aortic stenosis, "A judicious revascularization strategy selected by a dedicated heart team can result in favorable mid-term outcomes, obviating the need for complete coronary revascularization."

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Interventions and Coronary Artery Disease

Keywords: Coronary Artery Disease, Coronary Disease, Netherlands, Percutaneous Coronary Intervention

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