Objectives: Thoracic/abdominal aortic aneurysms and aortic stenosis may be concomitant diseases requiring both transcatheter aortic valve implantation (TAVI) and endovascular aneurysm repair (T/EVAR) in high-risk patients for surgical approaches, but temporal management is not clearly defined yet. The aim of the study was to analyse outcomes of simultaneous versus staged TAVI and T/EVAR. Methods: Retrospective observational multicentre study was performed on patients requiring TAVI and T/EVAR from 2016 to 2022. Patients were divided into 2 groups: 'Simultaneous group' if T/EVAR + TAVI were performed in the same procedure and 'Staged group' if T/EVAR and TAVI were performed in 2 steps, but within 3 months. Primary outcomes were technical success, 30-day mortality/major adverse events and follow-up survival. Secondary outcomes were procedural metrics and length of stay. Results: Forty-four cases were collected; 8 (18%) had T/EVAR and 36 (82%) had EVAR, respectively. Upon temporal determination, 25 (57%) and 19 (43%) were clustered in Simultaneous and Staged groups, respectively. In Staged group, median time between procedures was 72 (interquartile range-IQR: 57-87) days. Preoperative and intraoperative figures were similar. There was no difference in 30-day mortality (Simultaneous: 0/25 versus Staged: 1/19; P = 0.43). Pulmonary events (Simultaneous: 0/25 versus Staged: 5/19; P = 0.01) and need of postoperative cardiac pacemaker (Simultaneous: 2/25 versus Staged: 7/19; P = 0.02) were more frequent in Staged patients. The overall length of stay was lower in the Simultaneous group [Simultaneous: 7 (IQR: 6-8) versus Staged: 19 (IQR: 15-23) days; P = 0.001]. The median follow-up was 25 (IQR: 8-42) months and estimated 3-year survival was 73% with no difference between groups (Simultaneous: 82% versus Staged: 74%; P = 0.90). Conclusions: Both Simultaneous or Staged T/EVAR and TAVI procedures are effective with satisfactory outcomes. Despite the small numbers, simultaneous repair seems to reduce length of stay and pulmonary complications, maintaining similar follow-up survival.
Simultaneous versus staged approach in transcatheter aortic valve implantation for severe stenosis and endovascular aortic repair for thoracic and abdominal aortic aneurysm / Gallitto, Enrico; Spath, Paolo; Faggioli, Gian Luca; Saia, Francesco; Palmerini, Tullio; Piazza, Michele; D'Oria, Mario; Simonte, Gioele; Cappiello, Antonio; Isernia, Giacomo; Gelpi, Guido; Rizza, Antonio; Piffaretti, Gabriele; Gargiulo, Mauro; Null, Null; Antonello, M; Bellosta, R; Berti, S; Bramucci, A; Cappiello, A; Cecere, F; Di Marzo, L; D'Oria, M; Faggioli, G L; Freyrie, A; Gallitto, E; Gargiulo, M; Gelpi, G; Gennai, S; Isernia, G; Lepidi, S; Lodato, M; Marrozzini, C; Palmerini, T; Pratesi, G; Piazza, M; Mansour, W; Mezzetto, L; Piffaretti, G; Rizza, A; Saia, F; Silingardi, R; Simonte, G; Squizzato, F; Spath, P; Tinelli, G; Tozzi, M; Trimarchi, S; Veraldi, G F. - In: EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY. - ISSN 1873-734X. - 66:5(2024). [10.1093/ejcts/ezae379]
Simultaneous versus staged approach in transcatheter aortic valve implantation for severe stenosis and endovascular aortic repair for thoracic and abdominal aortic aneurysm
Freyrie, A;
2024-01-01
Abstract
Objectives: Thoracic/abdominal aortic aneurysms and aortic stenosis may be concomitant diseases requiring both transcatheter aortic valve implantation (TAVI) and endovascular aneurysm repair (T/EVAR) in high-risk patients for surgical approaches, but temporal management is not clearly defined yet. The aim of the study was to analyse outcomes of simultaneous versus staged TAVI and T/EVAR. Methods: Retrospective observational multicentre study was performed on patients requiring TAVI and T/EVAR from 2016 to 2022. Patients were divided into 2 groups: 'Simultaneous group' if T/EVAR + TAVI were performed in the same procedure and 'Staged group' if T/EVAR and TAVI were performed in 2 steps, but within 3 months. Primary outcomes were technical success, 30-day mortality/major adverse events and follow-up survival. Secondary outcomes were procedural metrics and length of stay. Results: Forty-four cases were collected; 8 (18%) had T/EVAR and 36 (82%) had EVAR, respectively. Upon temporal determination, 25 (57%) and 19 (43%) were clustered in Simultaneous and Staged groups, respectively. In Staged group, median time between procedures was 72 (interquartile range-IQR: 57-87) days. Preoperative and intraoperative figures were similar. There was no difference in 30-day mortality (Simultaneous: 0/25 versus Staged: 1/19; P = 0.43). Pulmonary events (Simultaneous: 0/25 versus Staged: 5/19; P = 0.01) and need of postoperative cardiac pacemaker (Simultaneous: 2/25 versus Staged: 7/19; P = 0.02) were more frequent in Staged patients. The overall length of stay was lower in the Simultaneous group [Simultaneous: 7 (IQR: 6-8) versus Staged: 19 (IQR: 15-23) days; P = 0.001]. The median follow-up was 25 (IQR: 8-42) months and estimated 3-year survival was 73% with no difference between groups (Simultaneous: 82% versus Staged: 74%; P = 0.90). Conclusions: Both Simultaneous or Staged T/EVAR and TAVI procedures are effective with satisfactory outcomes. Despite the small numbers, simultaneous repair seems to reduce length of stay and pulmonary complications, maintaining similar follow-up survival.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
