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Head S.J.,Erasmus Medical Center | Holmes Jr. D.R.,Mayo Medical School | Mack M.J.,Heart Health | Serruys P.W.,Erasmus Medical Center | And 4 more authors.
JACC: Cardiovascular Interventions | Year: 2012

Background: The aim of this study was to evaluate the use of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in "real-world" patients unsuitable for the alternative treatment. No data are available on the risk profile and outcomes of patients that can only undergo PCI or CABG. Methods: In the SYNTAX (Synergy between PCI with TAXUS and Cardiac Surgery) trial, a multidisciplinary Heart Team reached a consensus on whether PCI and CABG could result in clinical equipoise; if so, the patient was randomized. If not, the patient was enrolled in a CABG-ineligible PCI registry or PCI-ineligible CABG registry. A proportion (60%) of patients in the CABG registry was randomly assigned to be followed up for 5 years. No statistical comparisons were performed between randomized and registry patients. Major adverse cardiac or cerebrovascular event (MACCE) rates are presented as observational only. Results: A total of 3,075 patients were treated in the SYNTAX trial; 198 (6.4%) and 1,077 (35.0%) patients were included in PCI and CABG registries, respectively. The main reason for inclusion in the CABG registry was too complex coronary anatomy (70.9%), and the main reason for inclusion in the PCI registry was too high-risk for surgery (70.7%). Three-year MACCE was 38.0% after PCI and 16.4% after CABG. Stratification by SYNTAX score terciles demonstrated a step-wise increase of MACCE rates in both PCI and CABG registries. Conclusions: The SYNTAX Heart Team concluded that PCI and CABG remained the only treatment options for 6.4% and 35.0% of patients, respectively. Inoperable patients with major comorbidities that underwent PCI had high MACCE rates. In patients not suitable for PCI, surgical results were excellent. (SYNTAX Study: TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries, NCT00114972). © 2012 American College of Cardiology Foundation. Source


Kappetein A.P.,Erasmus Medical Center | Feldman T.E.,NorthShore University Health System | MacK M.J.,Baylor Healthcare System | Morice M.-C.,Institute Cardiovasculaire Paris Sud | And 6 more authors.
European Heart Journal | Year: 2011

Aims Long-term randomized comparisons of percutaneous coronary intervention (PCI) to coronary artery bypass grafting (CABG) in left main coronary (LM) disease and/or three-vessel disease (3VD) patients have been limited. This analysis compares 3-year outcomes in LM and/or 3VD patients treated with CABG or PCI with TAXUS Express stents. Methods and resultsSYNTAX is an 85-centre randomized clinical trial (n 1800). Prospectively screened, consecutive LM and/or 3VD patients were randomized if amenable to equivalent revascularization using either technique; if not, they were entered into a registry. Patients in the randomized cohort will continue to be followed for 5 years. At 3 years, major adverse cardiac and cerebrovascular events [MACCE: death, stroke, myocardial infarction (MI), and repeat revascularization; CABG 20.2 vs. PCI 28.0, P< 0.001], repeat revascularization (10.7 vs. 19.7, P< 0.001), and MI (3.6 vs. 7.1, P 0.002) were elevated in the PCI arm. Rates of the composite safety endpoint (death/stroke/MI 12.0 vs. 14.1, P 0.21) and stroke alone (3.4 vs. 2.0, P 0.07) were not significantly different between treatment groups. Major adverse cardiac and cerebrovascular event rates were not significantly different between arms in the LM subgroup (22.3 vs. 26.8, P 0.20) but were higher with PCI in the 3VD subgroup (18.8 vs. 28.8, P< 0.001). Conclusion sAt 3 years, MACCE was significantly higher in PCI-compared with CABG-treated patients. In patients with less complex disease (low SYNTAX scores for 3VD or low/intermediate terciles for LM patients), PCI is an acceptable revascularization, although longer follow-up is needed to evaluate these two revascularization strategies. © 2011 The Author. Source


Lefevre T.,Institute Cardiovasculaire Paris Sud | Girasis C.,Onassis Cardiac Surgery Center | Lassen J.F.,Copenhagen University
EuroIntervention | Year: 2015

The left main is the largest bifurcation of the coronary tree and is, therefore, easier to access. Nevertheless, the risks of untoward consequences associated with the loss of the side branch are much higher. Although the usual technical strategies implemented in coronary bifurcations can generally be applied to left main lesions, several inherent characteristics (the ostial position of the main branch, the size of the side branch, the amount of calcification, the angle which is often in a T shape, the use of stents of variable suitability, the crucial role of POT) need to be taken into account in order to achieve optimal acute and long-term results. © 2015 Europa Digital & Publishing. All rights reserved. Source


Hayashida K.,Institute Cardiovasculaire Paris Sud
EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology | Year: 2012

Significant aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) has been shown to be associated with worse mid-term outcome. The two-year follow-up results of the PARTNER US trial showed that not only ≥3/4 AR grade, but also grade 2 had a significant impact on mortality. Thus, prevention and treatment of significant AR after TAVI is of great importance. Usually, AR after TAVI consists mostly of paravalvular leak and significant central AR is uncommon. Here we describe measures to decrease the risk of AR after TAVI which are currently available. Source


Arai T.,Institute Cardiovasculaire Paris Sud | Lefevre T.,Institute Cardiovasculaire Paris Sud
Journal of Cardiology | Year: 2014

Transcatheter aortic valve implantation (TAVI) has rapidly emerged as a valid therapeutic option for patients with severe symptomatic aortic stenosis who are high risk or ineligible for conventional surgical aortic valve replacement. Despite its minimally invasive nature, TAVI is invariably associated with complications in these old patients that may affect outcomes. Although the success of TAVI is determined by multiple factors, good screening and appropriate patient selection is crucial. Selection of the right patient includes the determination of risk levels and feasibility of a safe procedure in each individual case. Here, we describe below our critical appraisal of patient selection for TAVI. © 2013. Source

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