Resultados de procedimientos híbridos de cirugía coronaria e implante transcatéter de la válvula aórtica concomitante

Introduction and objectives

Coronary artery disease may be present in 40-75% of patients with severe aortic stenosis who undergo transcatheter aortic valve implantation (TAVI). The aim is to evaluate the safety of a hybrid procedure in which coronary artery bypass grafting and TAVI are performed simultaneously with respect to conventional coronary artery bypass grafting and aortic prosthesis implantation with cardiopulmonary bypass.

Methods

Patients who underwent TAVI concomitantly with coronary revascularization off-pump were analyzed, consecutively, from when this procedure began in 2017 until the last patient operated on in 2020 (n = 19), compared with the cases operated on for biological aortic prosthesis implantation, with cardiopulmonary bypass, concomitantly with surgical coronary revascularization, in the last year 2021 (n = 24). Unified Valve Academic Research Consortium 3 (VARC-3) parameters were used.

Results

Regarding the preoperative variables, statistically significant differences were found in mean age (77,89 ± 5,91 years in the TAVI group compared to 70,33 ± 5,48 years in the conventional surgery group; p < 0.001), and in the rate of vascular disease (63,2% vs. 25%; p = 0,012). No differences were found in the number of coronary anastomoses performed between the two groups. In the postoperative results, only statistically significant differences were found in the rate of paravalvular regurgitation (47,4% vs. 8,3%; p = 0.005).

Conclusion

TAVI concomitantly with coronary artery bypass grafting has been shown to be safe with no statistically significant differences in the primary endpoints of mortality, stroke rate, and reoperations, as well as in the combined endpoints of technical success, device success, early safety, and of clinical efficacy.