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Surgical versus Interventional Treatment of Concomitant Aortic Valve Stenosis and Coronary Artery Disease

Ahmed Elderia1, Stephen Gerfer1, Kaveh Eghbalzadeh1

  • 1Department of Cardiothoracic Surgery, University of Cologne, Heart Center, Cologne, Germany.

The Thoracic and Cardiovascular Surgeon
|December 22, 2022
PubMed

Insights

Staged percutaneous coronary intervention and transcatheter aortic valve implantation (PCI+TAVI) offers short-term survival benefits over combined coronary artery bypass grafting and aortic valve replacement (CABG+AVR) for patients with coronary artery disease and aortic stenosis. However, PCI+TAVI is associated with increased risks of atrioventricular block and paravalvular leak.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Interventional Cardiology

Background:

  • Coronary artery disease (CAD) and aortic valve stenosis (AS) frequently coexist.
  • Treatment involves surgical (CABG+AVR) or interventional (PCI+TAVI) approaches.
  • Short-term outcomes of these strategies require comparative analysis.

Purpose of the Study:

  • To compare short-term outcomes of CABG+AVR versus staged PCI+TAVI in patients with CAD and AS.
  • To evaluate mortality, reintervention rates, and complications.
  • To inform treatment decisions for this complex patient population.

Main Methods:

  • Retrospective analysis of patients treated since 2017.
  • Identification of 237 patients undergoing PCI+TAVI and 241 patients undergoing CABG+AVR.
  • Propensity score matching to create 101 balanced pairs for comparison.

Main Results:

  • The PCI+TAVI group was older (81.4 vs 71.9 years) and had lower 30-day mortality (1.0% vs 4.9%) after matching.
  • CABG+AVR required more rethoracotomies (7.9% vs 2%) but fewer pacemakers (4.1% vs 6.9%).
  • PCI+TAVI showed a higher incidence of moderate-to-severe paravalvular leak (PVL) (4.9% vs 0%).

Conclusions:

  • Staged PCI+TAVI offers a short-term survival advantage compared to combined CABG+AVR.
  • PCI+TAVI is associated with a higher risk of atrioventricular block and PVL.
  • Long-term outcome data from further trials are necessary.
Abstract

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