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AAA 4. Simultaneous Transcatheter Aortic Valve Replacement and Endovascular Aortic Aneurysm Repair

      Objective

      The objective of this report was to present our experience with transcatheter aortic valve replacement (TAVR) and endovascular aneurysm repair (EVAR) performed simultaneously in patients with severe aortic stenosis and abdominal aortic aneurysm meeting criteria for repair.

      Methods

      This is a single-institution retrospective study. From 2015 to 2018, a total of five patients underwent simultaneous TAVR and EVAR at our institution. The primary outcome was mortality at 30 days. Secondary outcomes were length of stay, operative time, and acute kidney injury (increase in serum creatinine concentration of >0.5 mg/dL).

      Results

      All patients were white and most of them male (four of five patients). Age ranged from 80 to 87 years. Three of the four patients had grade 3 chronic kidney disease, and they all had hypertension. Access was percutaneous in three patients and open common femoral artery exposure in two patients. Operative time ranged between 98 and 177 minutes (mean, 124 minutes). Adjunctive endoanchor application was used in one patient with a short neck proximal to the abdominal aortic aneurysm. Average volume of contrast material used was 100 mL (range, 50-200 mL). Average length of stay was 5.2 days (range, 2-12 days). One patient developed a type II endoleak after EVAR that did not require reintervention. There were no instances of acute kidney injury. Four patients were discharged home and one was discharged to rehabilitation. Survival at 30 days was 100%.

      Conclusions

      Simultaneous performance of TAVR and EVAR appears to be a safe procedure. Our small case series did not show any complications specifically related to performing both procedures at the same time. There was no 30-day mortality. Procedure time and hospital length of stay were comparable to those of either procedure done separately.