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Updated: Jan 16, 2026

Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
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Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation

Published on: August 8, 2025

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Residual SYNTAX score and outcomes after TAVR+PCI versus SAVR+CABG: a propensity-matched, gender-based comparison

Max Potratz1,2, Vera Fortmeier3, Katharina Höflsauer3

  • 1Clinic for General and Interventional Cardiology/Angiology, Herz und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany MPotratz@hdz-nrw.de.

Open Heart
|October 1, 2025
PubMed

Insights

Transcatheter aortic valve replacement (TAVR) plus percutaneous coronary intervention (PCI) shows better outcomes when residual coronary artery disease (CAD) is low (rSS <8). Surgical aortic valve replacement (SAVR) plus coronary artery bypass grafting (CABG) outcomes depend more on patient risk.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Aortic stenosis (AS) and coronary artery disease (CAD) frequently coexist.
  • Surgical aortic valve replacement (SAVR) plus coronary artery bypass grafting (CABG) is traditional, while transcatheter aortic valve replacement (TAVR) plus percutaneous coronary intervention (PCI) is increasingly used.
  • Optimal revascularisation strategy, especially concerning residual CAD burden, remains unclear.

Purpose of the Study:

  • Investigate the impact of residual SYNTAX score (rSS) on outcomes in patients with AS and CAD.
  • Compare outcomes between TAVR+PCI and SAVR+CABG, considering gender differences.
  • Evaluate the prognostic importance of rSS in different revascularisation strategies.

Main Methods:

  • Retrospective analysis of propensity score-matched cohorts.
  • Included patients with AS and CAD undergoing either TAVR+PCI or SAVR+CABG.
  • Matching variables included age, ejection fraction, EuroSCORE II, and CAD severity.

Main Results:

  • Residual SYNTAX score (rSS) predicted outcomes in the TAVR+PCI group but not in the SAVR+CABG group.
  • TAVR+PCI was linked to lower composite endpoint rates when rSS <8, irrespective of gender.
  • TAVR+PCI showed safety benefits: lower major bleeding in men and lower stroke rates in women.

Conclusions:

  • The prognostic value of rSS is dependent on the chosen revascularisation strategy.
  • Achieving an rSS <8 is crucial for improved outcomes in TAVR+PCI procedures.
  • Prognosis after SAVR+CABG is primarily influenced by baseline clinical risk factors.
Abstract

Keywords:
Aortic Valve StenosisCoronary Artery BypassHeart Valve ProsthesisHeart Valve Prosthesis ImplantationTranscatheter Aortic Valve Replacement

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