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Transcatheter or Surgical Strategy for Aortic Stenosis and Coronary Artery Disease: A Kaplan-Meier-Derived

Massimo Baudo1, Pier Pasquale Leone2, Serge Sicouri1

  • 1Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania.

The American Journal of Cardiology
|December 17, 2025
PubMed

Insights

Transcatheter aortic valve replacement plus percutaneous coronary intervention (TAVR+PCI) offers early survival benefits for severe aortic stenosis and coronary artery disease patients. However, surgical aortic valve replacement plus coronary artery bypass grafting (SAVR+CABG) shows better mid-term survival.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Severe aortic stenosis (AS) frequently coexists with coronary artery disease (CAD).
  • Combined surgical aortic valve replacement (SAVR) and coronary artery bypass grafting (CABG) is the standard treatment.
  • Transcatheter aortic valve replacement (TAVR) with percutaneous coronary intervention (PCI) is an emerging alternative.

Purpose of the Study:

  • To compare clinical outcomes between TAVR+PCI and SAVR+CABG in patients with severe AS and CAD.
  • To evaluate all-cause mortality and other key clinical endpoints.

Main Methods:

  • Systematic review of randomized controlled and propensity score-matched studies up to December 2024.
  • Inclusion of six studies with 1,998 patients (1,007 TAVR+PCI, 991 SAVR+CABG).
  • Analysis of Kaplan-Meier-derived individual patient data for primary endpoint: all-cause mortality.

Main Results:

  • TAVR+PCI demonstrated an early survival advantage (first 19 days).
  • SAVR+CABG showed improved survival at 73 days.
  • TAVR+PCI had lower rates of stroke-free survival, postoperative reintervention, atrial fibrillation, and acute kidney injury.
  • TAVR+PCI was associated with higher risks of moderate/severe aortic regurgitation, pacemaker implantation, and vascular complications.

Conclusions:

  • Percutaneous treatment (TAVR+PCI) provides an early survival benefit in severe AS and CAD patients.
  • Surgical treatment (SAVR+CABG) is associated with better mid-term survival.
  • The choice between TAVR+PCI and SAVR+CABG requires careful consideration of short-term versus mid-term outcomes.

Keywords:
CABGmeta-analysispercutaneous coronary interventionsurgical aortic valve replacementtranscatheter aortic valve implantation

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