OBJECTIVE

To evaluate the efficacy and safety of transcatheter aortic valve implantation (TAVI) in patients with severe coronary artery (CA) lesions without prior myocardial revascularization.

MATERIAL AND METHODS

A retrospective study included 270 patients who underwent TIA in 2016-2021. In some patients (n=200, group 1), TAVI was performed after preliminary percutaneous coronary intervention (PCI), in other cases (n=70, group 2) — without prior PCI. Propensity score matching was performed. Finally, we distinguished 2 groups by 68 patients. These groups were comparable regarding clinical and demographic parameters. In-hospital and long-term results were studied. The median follow-up was 40 months.

RESULTS

In-hospital mortality was low in both groups (1.5% and 0%, p=1.0). The incidence of perioperative myocardial infarction (MI) and myocardial injury was comparable. Any in-hospital bleeding (19% vs 2%; OR=15.8, 95% CI 2.0-124.9, p=0.001) and bleeding requiring blood transfusion (12% vs 0%; OR =17.0; 95% CI 0.96-300.4, p=0.006) were more common in the 1^st group. In long-term period, the incidence of persistent angina pectoris (22% and 19%, p=0.645), MI (5% and 4%, p=0.723) and mortality rate (14% and 15%, p=0.845) were comparable. Significant differences were obtained regarding postoperative bleeding BARC grade ≥2 (16% vs. 4%; OR=12.2; 95% CI 1.5-97.9, p=0.001).

CONCLUSION

Routine PCI before TAVI does not reduce the risk of perioperative cardiac ischemic complications and increases the risk of bleeding both at the in-hospital stage and in long-term period. In case of severe CA lesions, TAVI can be performed without prior PCI.