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Updated: Aug 27, 2025

Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement

Published on: March 26, 2018

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Complete transcatheter versus surgical approach to aortic stenosis with coronary artery disease: A systematic review

Yosuke Sakurai1, Yujiro Yokoyama2, Shinichi Fukuhara3

  • 1Department of Surgery, Marshall University Joan Edwards School of Medicine, WVa.

The Journal of Thoracic and Cardiovascular Surgery
|September 23, 2022
PubMed

Insights

Transcatheter aortic valve replacement (TAVR) with percutaneous coronary intervention (PCI) showed higher mortality and repeat interventions compared to surgical aortic valve replacement (SAVR) with coronary artery bypass grafting (CABG). A Heart Team approach is crucial for patient selection.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Severe aortic stenosis with concurrent coronary artery disease presents a complex treatment challenge.
  • Choosing between transcatheter aortic valve replacement (TAVR) with percutaneous coronary intervention (PCI) and surgical aortic valve replacement (SAVR) with coronary artery bypass grafting (CABG) requires careful consideration of outcomes.

Approach:

  • A comprehensive meta-analysis was conducted, synthesizing data from two randomized controlled trials and six observational studies.
  • The analysis included a large patient cohort (104,220 patients) comparing TAVR + PCI versus SAVR + CABG.
  • Outcomes evaluated included mortality, reintervention, rehospitalization, myocardial infarction, stroke, and periprocedural complications.

Key Points:

  • TAVR + PCI was linked to increased all-cause mortality and coronary reintervention during follow-up.
  • Higher rates of permanent pacemaker implantation and vascular complications were observed with TAVR + PCI.
  • Conversely, TAVR + PCI demonstrated a lower incidence of 30-day acute kidney injury.

Conclusions:

  • For patients with severe aortic stenosis and coronary artery disease, TAVR + PCI is associated with greater long-term all-cause mortality compared to SAVR + CABG.
  • The findings underscore the continued importance of a Heart Team approach for optimal TAVR candidacy assessment and treatment planning.
Abstract

Keywords:
aortic stenosiscoronary artery diseasetranscatheter aortic valve replacement

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