Combined Treatment for Coronary Artery Disease and Aortic Valve Stenosis

Background: The aim of the present study was to analyze the short- and mid-term outcomes after transcatheter aortic valve replacement (TAVR) in patients with complex coronary artery disease (CAD).

Methods: Between January 2010 and December 2020, 1,232 patients underwent TAVR and percutaneous coronary intervention (PCI) or surgical aortic valve replacement (SAVR) with coronary artery bypass grafting (CABG) at our center. The primary endpoint was short-term mortality. Secondary endpoints included major adverse cardiovascular and cerebrovascular events (MACCE) and mid-term mortality.

Results: Seventy-six pairs of patients (TAVR PCI versus SAVR CABG) with intermediate STS risk scores 3.0 ± 1.7 versus 3.4 ± 1.2 and EUROScore II 6.89 ± 4.3 versus 7.41 ± 4.7, respectively, were generated after 1:1 propensity score matching. There were no differences between groups for all-cause mortality (p = 0.262), stroke (p = 0.527), or myocardial infarction (p = 0.474) during a mid-term follow-up period. Similarly, there were no differences in the rate of re-do procedures between groups (p = 0.515, HR 2.1, 95%CI [0.282 to 15.200]). The rates of MACCE (p = 0.061, HR 1.8, 95%CI [0.938 to 3.509]) and new pacemaker implantation (p = 0.087; 0.5 HR, 95%CI [0.187 to 1.089]) were higher in the TAVR + PCI group. The rate of prosthetic valve regurgitation (>2°) was lower in the SAVR + CABG group, and the mean gradients were lower in the TAVR + PCI group.

Conclusion: The outcomes of the percutaneous transcatheter approach are similar to those of a surgical procedure. However, SAVR + CABG was superior to TAVR + PCI in terms of MACCE and new pacemaker implantation rates. Future trials are needed to guide clinical decisions.

Publikationsverlauf

Artikel online veröffentlicht:
11. Februar 2025