Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Complex Coronary Artery Disease |
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| Institution: | 1. Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada;2. Rangueil University Hospital, Toulouse, France;3. Hospital Universitario Virgen de la Victoria, Malaga, Spain;4. Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain;5. Reims University Hospital, Reims, France;6. Hospital Marques de Valdecilla, Santander, Spain;7. Hospital Universitari Vall d’Hebron, Barcelona, Spain;8. Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France;9. Hospital Universitario Central de Asturias, Oviedo, Spain;10. Hospital Santa Creu i Sant Pau, Barcelona, Spain;11. Hospital Gregorio Maranon, Madrid, Spain;12. Hospital Clinic de Barcelona, Barcelona, Spain;13. Hospital Germans Trias i Pujol, Badalona, Spain;14. Instituto do Coração (InCor), Heart Institute, University of Sao Paulo, Sao Paulo, Brazil |
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| Abstract: | ObjectivesThe aim of this study was to compare, in a cohort of patients with complex coronary artery disease (CAD) and severe aortic stenosis (AS), the clinical outcomes associated with transfemoral transcatheter aortic valve replacement (TAVR) (plus percutaneous coronary intervention PCI]) versus surgical aortic valve replacement (SAVR) (plus coronary artery bypass grafting CABG]).BackgroundPatients with complex CAD were excluded from the main randomized trials comparing TAVR with SAVR, and no data exist comparing TAVR + PCI vs SAVR + CABG in such patients.MethodsA multicenter study was conducted including consecutive patients with severe AS and complex CAD (SYNTAX Synergy Between PCI with Taxus and Cardiac Surgery] score >22 or unprotected left main disease). A 1:1 propensity-matched analysis was performed to account for unbalanced covariates. The rates of major adverse cardiac and cerebrovascular events (MACCE), including all-cause mortality, nonprocedural myocardial infarction, need for new coronary revascularization, and stroke, were evaluated.ResultsA total of 800 patients (598 undergoing SAVR + CABG and 202 undergoing transfemoral TAVR + PCI) were included, and after propensity matching, a total of 156 pairs of patients were generated. After a median follow-up period of 3 years (interquartile range: 1-6 years), there were no significant differences between groups for MACCE (HR for transfemoral TAVR vs SAVR: 1.33; 95% CI: 0.89-1.98), all-cause mortality (HR: 1.25; 95% CI: 0.81-1.94), myocardial infarction (HR: 1.16; 95% CI: 0.41-3.27), and stroke (HR: 0.42; 95% CI: 0.13-1.32), but there was a higher rate of new coronary revascularization in the TAVR + PCI group (HR: 5.38; 95% CI: 1.73-16.7).ConclusionsIn patients with severe AS and complex CAD, TAVR + PCI and SAVR + CABG were associated with similar rates of MACCE after a median follow-up period of 3 years, but TAVR + PCI recipients exhibited a higher risk for repeat coronary revascularization. Future trials are warranted. |
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| Keywords: | aortic stenosis coronary artery disease surgical aortic valve replacement transcatheter aortic valve replacement AS"} {"#name":"keyword" "$":{"id":"kwrd0035"} "$$":[{"#name":"text" "_":"aortic stenosis CABG"} {"#name":"keyword" "$":{"id":"kwrd0045"} "$$":[{"#name":"text" "_":"coronary artery bypass grafting CAD"} {"#name":"keyword" "$":{"id":"kwrd0055"} "$$":[{"#name":"text" "_":"coronary artery disease MACCE"} {"#name":"keyword" "$":{"id":"kwrd0085"} "$$":[{"#name":"text" "_":"major adverse cardiac and cerebrovascular event(s) PCI"} {"#name":"keyword" "$":{"id":"kwrd0095"} "$$":[{"#name":"text" "_":"percutaneous coronary intervention PS"} {"#name":"keyword" "$":{"id":"kwrd0105"} "$$":[{"#name":"text" "_":"propensity score SAVR"} {"#name":"keyword" "$":{"id":"kwrd0115"} "$$":[{"#name":"text" "_":"surgical aortic valve replacement STS"} {"#name":"keyword" "$":{"id":"kwrd0125"} "$$":[{"#name":"text" "_":"Society of Thoracic Surgeons TAVR"} {"#name":"keyword" "$":{"id":"kwrd0135"} "$$":[{"#name":"text" "_":"transcatheter aortic valve replacement |
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