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Percutaneous versus surgical approach to aortic valve replacement with coronary revascularization: A systematic

Yujian Guo1, Wei Zhang2, Haibo Wu2

  • 1Department of Graduate School, Changzhi Medical College, Changzhi, Shanxi, China.

Perfusion
|May 24, 2023
PubMed

Insights

Transcatheter aortic valve replacement (TAVR) with percutaneous coronary intervention (PCI) showed no increase in perioperative mortality compared to surgical aortic valve replacement (SAVR) with coronary artery bypass grafting (CABG). However, TAVR + PCI was linked to higher rates of coronary reintervention and reduced long-term survival.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Severe aortic stenosis (AS) and complex coronary artery disease (CAD) present a challenging treatment scenario.
  • The optimal management strategy for these patients is debated, necessitating comparative outcome analysis.

Purpose of the Study:

  • To compare outcomes of transcatheter aortic valve replacement (TAVR) combined with percutaneous coronary intervention (PCI) against surgical aortic valve replacement (SAVR) combined with coronary artery bypass grafting (CABG).

Main Methods:

  • A meta-analysis was performed on six observational studies up to December 2022.
  • Included were 135,003 patients (TAVR+PCI: n=6988; SAVR+CABG: n=128,015).
  • Primary outcome was perioperative mortality; secondary outcomes included complications, bleeding, hospital stay, and long-term survival.

Main Results:

  • TAVR + PCI did not significantly increase perioperative mortality, vascular complications, acute kidney injury, myocardial infarction, or stroke compared to SAVR + CABG.
  • TAVR + PCI significantly reduced major bleeding and length of hospital stay but increased pacemaker implantation.
  • Long-term follow-up revealed TAVR + PCI was associated with higher coronary reintervention rates and reduced long-term survival.

Conclusions:

  • For patients with AS and CAD, TAVR + PCI is a viable alternative to SAVR + CABG regarding perioperative mortality.
  • The increased need for coronary reintervention and decreased long-term survival with TAVR + PCI warrants careful consideration in treatment decisions.
Abstract

Keywords:
coronary artery bypass graftingmeta-analysispercutaneous coronary interventionsurgical aortic valve replacementtranscatheter aortic valve replacement

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