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Aortic Stenosis With Coronary Artery Disease: SAVR or TAVR-When and How?

Juan Hernando Del Portillo1, Julio Farjat-Pasos1, Attilio Galhardo1

  • 1Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.

The Canadian Journal of Cardiology
|September 27, 2023
PubMed

Insights

For severe aortic stenosis and coronary artery disease, surgical aortic valve replacement with bypass grafting is best for complex cases. Transcatheter aortic valve replacement with intervention suits high-risk patients.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Increasing transcatheter aortic valve replacement (TAVR) candidates with severe aortic stenosis (AS) also have coronary artery disease (CAD).
  • Optimal revascularization strategies for concurrent AS and CAD require careful consideration due to potential impacts on outcomes.
  • Prevalence of concurrent AS and CAD varies based on definitions and study populations.

Purpose of the Study:

  • To define the appropriate revascularization strategy for patients with concomitant severe aortic stenosis and coronary artery disease.
  • To compare outcomes of different revascularization approaches in this patient group.
  • To identify factors influencing the choice between TAVR+PCI and SAVR+CABG.

Main Methods:

  • Review of existing literature comparing surgical aortic valve replacement with coronary artery bypass grafting (SAVR+CABG) versus transcatheter aortic valve replacement with percutaneous coronary intervention (TAVR+PCI).
  • Analysis of outcomes including mortality, stroke, and major cardiovascular events based on CAD complexity and surgical risk.
  • Consideration of factors like PCI timing, ejection fraction, and valve durability.

Main Results:

  • SAVR+CABG shows favorable long-term prognosis.
  • TAVR+PCI outcomes depend on CAD complexity and revascularization completeness.
  • No significant differences in mortality or stroke between SAVR+CABG and TAVR+PCI in low-intermediate risk/CAD patients.
  • SAVR+CABG may offer lower major cardiovascular events in complex CAD patients.

Conclusions:

  • SAVR+CABG is preferred for low-intermediate surgical risk patients with complex CAD.
  • TAVR+PCI is suitable for high surgical risk patients needing complete or reasonable incomplete revascularization.
  • Further research is needed on alternative CAD assessment methods for guiding revascularization in severe AS patients.

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