Complete transcatheter versus complete surgical treatment in patients with aortic valve stenosis and concomitant coronary artery disease: Study‐level meta‐analysis with reconstructed time‐to‐event data

Abstract

Objectives: To compare outcomes of complete transcatheter (TAVI plus PCI) versus complete surgical (SAVR plus CABG) approach to treat patients with aortic stenosis (AS) and concomitant coronary artery disease (CAD).Methods: Study-level meta-analysis with reconstructed time-to-event data including studies published by November 2021. The primary endpoints were 30-day mortality, overall survival, and major adverse cardiovascular and cerebrovascular events (MACCE). The secondary endpoints were 30-day stroke, myocardial infarction, and permanent pacemaker implantation (PPI); in-hospital major vascular events and acute kidney injury (AKI).Results: Eight studies met our eligibility criteria, including a total of 33,286 patients (3448 for TAVI plus PCI and 29,838 for SAVR plus CABG). The pooled risk of 30-day mortality was lower for TAVI plus PCI (OR 0.63; 95% CI 0.51-0.80; p < .001).Patients undergoing TAVI plus PCI had lower risk of in-hospital AKI (OR 0.49; 95% CI 0.28-0.85; p = .01), however, higher risk of major vascular events (OR 7.33; 95% CI 1.80-29.85; p = .005) and higher risk of PPI (OR 2.96; 95% CI 1.80-4.85; p < .001).No statistically significant difference was observed for myocardial infarction and stroke between the groups. In the follow-up analyses, we observed a higher risk of

Coronary artery disease and TAVI: Current evidence on a recurrent issue

“…The first group was exposed to a higher risk of periprocedural major vascular complications 30 . Younger age, resulting in longer life expectancy, of patient candidates to cardiac surgery might explain the benefits of concomitant CABG in terms of late postoperative adverse events occurrence (cardiovascular death, MI, and stroke) 31 . Far from this scenario, a consistent proportion of patients undergoing transcatheter interventions belong to the octogenarian population.…”

“…30 Younger age, resulting in longer life expectancy, of patient candidates to cardiac surgery might explain the benefits of concomitant CABG in terms of late postoperative adverse events occurrence (cardiovascular death, MI, and stroke). 31…”

Complete transcatheter versus complete surgical management for combined aortic stenosis and coronary artery disease: A false dichotomy?

“…In this issue of JOCS, Sá et al attempt to delineate the exact benefits and drawbacks of each of these procedural approaches using a studylevel meta-analysis with reconstructed time-to-event data. 2 In their analysis spanning eight studies with over 33,000 patients, the authors notably documented a long-term mortality benefit of SAVR-CABG compared to TAVI-PCI, despite its higher risk of 30-day mortality. SAVR-CABG was also associated with a lower risk of major adverse cardiovascular and cerebrovascular events, major vascular events, and permanent pacemaker implantation, while TAVI-PCI demonstrated benefit in reducing the risk of acute kidney injury at 5-year follow-up.…”

“…However, significantly more data, both in volume and in the length of follow‐up, are available for the conventional surgical approaches for such patients including combined surgical aortic valve replacement (SAVR) and coronary artery bypass grafting (CABG). In this issue of JOCS , Sá et al attempt to delineate the exact benefits and drawbacks of each of these procedural approaches using a study‐level meta‐analysis with reconstructed time‐to‐event data 2 …”

TAVISCORE: a computer program for risk stratification of complications after aortic valve interventions in patients with reduced ejection fraction

“…Реконструктивные вмешательства на аортальном клапане (АК) всегда находились в центре внимания кардиохирургов [1,2]. В настоящее время существует два наиболее популярных варианта коррекции стеноза АК: открытое протезирование (ОПАК) и транскатетерная имплантация АК (ТИАК) [3].…”