Surgical versus Interventional Treatment of Concomitant Aortic Valve Stenosis and Coronary Artery Disease

Abstract

Coronary artery disease is frequently diagnosed in patients with aortic valve stenosis. Treatment options include surgical and interventional approaches. We therefore analyzed short-term outcomes of patients undergoing either coronary artery bypass grafting with simultaneous aortic valve replacement (CABG+AVR) or staged percutaneous coronary intervention and transcatheter aortic valve implantation (PCI+TAVI). Methods: From all patients treated since 2017 we retrospectively identified 237 patients undergoing TAVI within 6 months after PCI and 241 patients undergoing combined CABG+AVR surgery. Propensity score matching was performed resulting in 101 matched pairs. Results: patients in the CABG+AVR group were younger compared to patients in the PCI+TAVI group (71.9±4.9 vs. 81.4±3.6 years; p<0.001). The overall mortality at 30 days before matching was higher after CABG+AVR than after PCI+TAVI (7.8% vs. 2.1%; p=0.012). The paired cohort was balanced for both groups regarding demographic variables and the risk profile (age: 77.2±3.7 vs.78.5±2.7 years; p=0.141) and Euro Score II (6.2% vs. 7.6%; p=0.297). At 30 days, mortality was 4.9% in the CABG+AVR group and 1,0% in the PCI+TAVI group and (p=0.099). Re-thoracotomy was necessary in 7.9% in the CABG+AVR, while conversion to open heart surgery was necessary in 2 % in the PCI+TAVI group. The need for new pacemaker was lower after CABG+AVR than after PCI+TAVI (4.1% vs.6.9%; p=0.010). No paravalvular leak was noted in the CABG+AVR group, while the incidence of moderate to severe PVL after PCI+TAVI was 4.9 %; (p=0.027). Conclusion: A staged PCI+TAVI comprises a short-term survival advantage for management of CAD and AS. Long-term Trials are warranted.