Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Coronary access after transcatheter aortic valve replacement (TAVR) remains challenging, particularly with tall-framed valves (TFVs), raising concerns about long-term percutaneous coronary intervention (PCI). OBJECTIVES: The aim of this study was to evaluate the impact of bioprosthetic aortic valve type on long-term clinical outcomes in patients undergoing PCI following TAVR. METHODS: Data were derived from the multicenter REVIVAL-PCI registry, which included patients from 21 European centers who underwent PCI after TAVR between 2008 and 2023. Patients were classified according to valve frame height: TFVs or short-framed valves (SFVs). The primary endpoint was the 4-year incidence of major adverse cardiovascular events, defined as the composite of cardiovascular death, myocardial infarction, or stroke. Cumulative event rates were estimated using Kaplan-Meier method, and weighted Cox regression models using an entropy balance approach were used to adjust for imbalances in clinical and procedural confounders. RESULTS: The analysis included 441 patients, with 230 having undergone TAVR with SFVs (30.9% women) and 211 with TFVs (44.1% women). The median follow-up after PCI was 908 days (Q1-Q3: 322-1,728 days). The 4-year incidence of major adverse cardiovascular events was comparable between the SFV and TFV groups (38.1% [95% CI: 24.6%-43.9%] vs 31.9% [95% CI: 24.8%-41.0%]; HR: 1.04; 95% CI: 0.71-1.52; P = 0.846). Similar findings were observed after adjustment for potential confounders. CONCLUSIONS: In current practice, long-term outcomes after PCI in TAVR patients do not appear to be significantly different between those receiving SFVs and TFVs. Future investigations with newer generation valves and refined implantation techniques are needed to clarify these associations and optimize management strategies.
Authors: Carlo A. Pivato, Emanuele Di Angelantonio, Francesco Tartaglia, Gianluigi Condorelli, Nicole Fontana, Francesca Ieva, Cosmo Godino, Masaaki Nakase, Karsten Hug, Tobias Rheude, Antonio J. Munoz-Garcia, Victor Alfonso Jimenez Diaz, Alfonso Ielasi, Marco Barbanti, Giuliano Costa, Angelo Anzuini, Giorgio Quadri, Diego Lopez-Otero, Philippe Garot, Ferdinando Varbella, Jorn Brouwer, Leon Gramss, Davide Cao, Stefano Figliozzi, Damiano Regazzoli, Luca Testa, Jorge Sanz Sanchez, Daijiro Tomii, Alaide Chieffo, Michael Joner, Gennaro Sardella, Enrico Cerrato, Luis Nombela-Franco, Thomas Pilgrim, Giulio Stefanini
Institutions: Humanitas University, IRCCS Humanitas Research Hospital, University of Cambridge, British Heart Foundation, National Institute for Health and Care Research, Human Technopole, Politecnico di Milano, Vita-Salute San Raffaele University, IRCCS Ospedale San Raffaele, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele, University of Bern, University Hospital of Bern, Deutsches Herzzentrum München, Technical University of Munich, Hospital Clínico Universitario Virgen de la Victoria, University Hospital Complex Of Vigo, IRCCS Ospedale Galeazzi - Sant'Ambrogio, Università degli Studi di Enna Kore, Azienda Ospedaliero Universitaria Policlinico "G.Rodolico - San Marco", Humanitas Mater Domini, Complejo Hospitalario de Pontevedra, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ospedale San Luigi Gonzaga, St. Antonius Ziekenhuis, Humanitas Gavazzeni, IRCCS Policlinico San Donato, Hospital Universitari i Politècnic La Fe, Centro de Investigación Biomédica en Red, TUM Klinikum, Policlinico Umberto I, Ospedale degli Infermi, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $5,000
Funder: Ministero della Salute
OpenAlex ID: W4415547299