Feasibility and outcomes of combined transcatheter aortic valve replacement with other structural heart interventions in a single session: a matched cohort study

Khattab, Ahmed Aziz; Glökler, Steffen; Sprecher, Beate; Shakir, Samera; Guerios, Ênio; Stortecky, Stefan; O'Sullivan, Crochan John; Nietlispach, Fabian; Moschovitis, Aris; Pilgrim, Thomas; Büllesfeld, Lutz; Wenaweser, Peter Martin; Windecker, Stephan; Meier, Bernhard (2014). Feasibility and outcomes of combined transcatheter aortic valve replacement with other structural heart interventions in a single session: a matched cohort study. Open Heart, 1(1), e000014. B M J Group 10.1136/openhrt-2013-000014

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Background

Concurrent cardiac diseases are frequent among elderly patients and invite simultaneous treatment to ensure an overall favourable patient outcome.
Aim

To investigate the feasibility of combined single-session percutaneous cardiac interventions in the era of transcatheter aortic valve implantation (TAVI).
Methods

This prospective, case–control study included 10 consecutive patients treated with TAVI, left atrial appendage occlusion and percutaneous coronary interventions. Some in addition had patent foramen ovale or atrial septal defect closure in the same session. The patients were matched in a 1:10 manner with TAVI-only cases treated within the same time period at the same institution regarding their baseline factors. The outcome was validated according to the Valve Academic Research Consortium (VARC) criteria.
Results

Procedural time (126±42 vs 83±40 min, p=0.0016), radiation time (34±8 vs 22±12 min, p=0.0001) and contrast dye (397±89 vs 250±105 mL, p<0.0001) were higher in the combined intervention group than in the TAVI-only group. Despite these drawbacks, no difference in the VARC endpoints was evident during the in-hospital period and after 30 days (VARC combined safety endpoint 32% for TAVI only and 20% for combined intervention, p=1.0).
Conclusions

Transcatheter treatment of combined cardiac diseases is feasible even in a single session in a high-volume centre with experienced operators.

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