Purpose: To study the effectiveness and safety of combined PCI and aortic valve implantation in patients at high surgical risk.
Material and Methods: combined correction of aortic stenosis and PCI was performed in 15 patients. The average age of patients was 76,3 ±4,7 years. All patients had severe aortic stenosis and were in NYHA class III-IV. At baseline EchoCG, the average systolic pressure gradient across the aortic valve was 80,1 ±24,9 mm Hg, maximal gradient 117,5 ± 24,4 mm Hg, the area of AV orifice - 0,6 ± 0,27 mm². Surgical risk, as assessed by EuroScore was > 25%, by STS > 15%. Four patients has single-vessel disease, 10 – two-vessel, 1-three-vessel disease. SYNTAX score was 12,4 ± 5,2. Average number of stents per patient was 1.8.
Results: Combined TAVI (CoreValve System) and PCI were successfully performed in all patients, without death or intra- and postoperative complications. The average duration of the procedure was 126,3 ± 32,4 min, the time of scopy 35,2 ± 14,27 min. The average volume of the contrast medium was 258,3±22,5 ml. According to EchoCG, after the procedure maximal systolic pressure gradient of the aortic valve was 18,6 ±6 mm Hg, in 30 days – 17,3 ± 0,6 mm Hg. The duration of hospital stay did not exceed 8 days. At day 30, none of the patients had angina pain, the signs of heart failure were absent.
Conclusions: Transcatheter aortic valve implantation combined with percutaneous coronary interventions can be successfully used for the management of patients at extremely high risk for open-heart surgery and is the only method of treatment for them.
