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Simultaneous versus staged approach in transcatheter aortic valve implantation for severe stenosis and endovascular aortic repair for thoracic and abdominal aortic aneurysm

2024; Oxford University Press; Linguagem: Inglês

10.1093/ejcts/ezae379

1873-734X

Enrico Gallitto, Paolo Spath, Gianluca Faggioli, Francesco Saia, Tullio Palmerini, Michele Piazza, Mario D’Oria, Gioele Simonte, Antonio Cappiello, Giacomo Isernia, Guido Gelpi, Antonio Rizza, Gabriele Piffaretti, Mauro Gargiulo, Michele Antonello, Raffaello Bellosta, Stefano Berti, Alberto Bramucci, Antonio Cappiello, Fabiana Letizia Cecere, Luca di Marzo, Mario D’Oria, Gianluca Faggioli, Antonio Freyrie, E Gallitto, Marcela Gargiulo, Guido Gelpi, Stefano Gennai, Giacomo Isernia, S Lepidi, Melissa Lodato, Cinzia Marrozzini, Tullio Palmerini, Giovanni Pratesi, Michele Piazza, Wassim Mansour, Luca Mezzetto, Gabriele Piffaretti, Antonio Rizza, Francesco Saia, R Silingardi, G Simonte, Francesco Squizzato, Paolo Spath, Giovanni Tinelli, Margherita Tozzi, S Trimarchi, Veraldi Gf,

Cardiac, Anesthesia and Surgical Outcomes

Abstract OBJECTIVES Thoracic/abdominal aortic aneurysms(T/AAAs) and aortic stenosis(AS) 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. Aim of the study was to analyze outcomes of simultaneous vs staged TAVI and T/EVAR. METHODS Retrospective observational multicentre study 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 two 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 (LOS). RESULTS Forty-four cases were collected; 8(18%) had TEVAR and 36(82%) 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(Simultanoeus : 0/25 vs Staged : 1/19; p = 0.43). Pulmonary events(Simultaneous : 0/25 vs Staged : 5/19; p = 0.01) and need of postoperative cardiac pacemaker(Simultaneous : 2/25 vs Staged : 7/19; p = 0.02) were more frequent in Staged patients. The overall LOS was lower in Simultaneous group[Simultaneous : 7(IQR : 6–8) vs 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(Simultanoeus : 82% vs 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.