Outcomes of Concomitant Percutaneous Coronary Intervention and Balloon Aortic Valvuloplasty

Background: Coronary artery disease often coexists with severe aortic stenosis. The feasibility and safety of combined balloon aortic valvuloplasty (BAV) and percutaneous coronary intervention (PCI) are unknown. Aim: To compare outcomes and complications of combined BAV and PCI with BAV alone. Methods: The study cohort consisted of 409 patients with severe aortic stenosis undergoing BAV from 1/2007 to 12/2010. Overall, 329 patients underwent BAV alone and 80 underwent concomitant PCI. Clinical and hemodynamic data, as well as acute and intermediate-term outcomes, were collected. Results: At the operator's discretion PCI was done before BAV in 66 (82.5%) and after in 14 (17.5%). Patients who underwent concomitant procedures had a higher incidence of prior stroke and a lower incidence of atrial fibrillation. Procedure time and fluoroscopic time were significantly greater in the BAV/ PCI group, (90.0 +/- 36.6 vs. 72.8 +/- 39.8, P = 0.002 and 20.5 +/- 10.9 vs. 12.9 +/- 7.0, P < 0.001). Significantly more radiographic contrast was used in the BAV/ PCI group (95.1 +/- 45.5 vs. 36.7 +/- 38.4 cm(3), P < 0.001. Serious adverse events occurred with equal frequency 13.7 and 17.3%, P = 0.44). Transfusion requirement was also similar (21.2% vs. 20.0%, P = 0.81). The frequency of a periprocedural increase in troponin or creatinine was also similar. In the BAV alone group the mortality rate was 48.6% (n = 160) during a mean follow-up of 191 days, and in the BAV/ PCI group the mortality rate was 40% (n = 32) during mean follow-up of 175.5 day, P = 0.34. Conclusion: Combined BAV and PCI are safe and are associated with similar complications as BAV alone and may offer protection against myocardial ischemia during BAV. (C) 2011 Wiley Periodicals, Inc.