%0 Journal Article
%A Alperi, Alberto
%A Mohammadi, Siamak
%A Campelo-Parada, Francisco
%A Munoz-Garcia, Erika
%A Nombela-Franco, Luis
%A Faroux, Laurent
%A Veiga, Gabriela
%A Serra, Vicenc
%A Fischer, Quentin
%A Pascual, Isaac
%A Asmarats, Luis
%A Gutierrez, Enrique
%A Regueiro, Ander
%A Vilalta, Victoria
%A Ribeiro, Henrique B.
%A Matta, Anthony
%A Munoz-Garcia, Antonio
%A Armijo, German
%A Metz, Damien
%A de la Torre Hernandez, Jose M.
%A Rodenas-Alesina, Eduard
%A Urena, Marina
%A Moris, Cesar
%A Arzamendi, Dabit
%A Perez-Fuentes, Pedro
%A Fernandez-Nofrerias, Eduard
%A Campanha-Borges, Diego Carter
%A Mesnier, Jules
%A Voisine, Pierre
%A Dumont, Eric
%A Kalavrouziotis, Dimitri
%A Rodes-Cabau, Josep
%T Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Complex Coronary Artery Disease
%D 2021
%@ 1936-8798
%U https://hdl.handle.net/10668/26865
%X OBJECTIVES The aim of this study was to compare, in a cohort of patients with complex coronary artery disease (CAD) and severe aortic stenosis (AS), the clinical outcomes associated with transfemoral transcatheter aortic valve replacement (TAVR) (plus percutaneous coronary intervention [PCI]) versus surgical aortic valve replacement (SAVR) (plus coronary artery bypass grafting [CABG]). BACKGROUND Patients with complex CAD were excluded from the main randomized trials comparing TAVR with SAVR, and no data exist comparing TAVR + PCI vs SAVR + CABG in such patients. METHODS A multicenter study was conducted including consecutive patients with severe AS and complex CAD (SYN-TAX [Synergy Between PCI with Taxus and Cardiac Surgery] score >22 or unprotected left main disease). A 1:1 propensity-matched analysis was performed to account for unbalanced covariates. The rates of major adverse cardiac and cere-brovascular events (MACCE), including all-cause mortality, nonprocedural myocardial infarction, need for new coronary revascularization, and stroke, were evaluated. RESULTS A total of 800 patients (598 undergoing SAVR + CABG and 202 undergoing transfemoral TAVR + PCI) were included, and after propensity matching, a total of 156 pairs of patients were generated. After a median follow-up period of 3 years (interquartile range: 1-6 years), there were no significant differences between groups for MACCE (HR for transfemoral TAVR vs SAVR: 1.33; 95% CI: 0.89-1.98), all-cause mortality (HR: 1.25; 95% CI: 0.81-1.94), myocardial infarction (HR: 1.16; 95% CI: 0.41-3.27), and stroke (HR: 0.42; 95% CI: 0.13-1.32), but there was a higher rate of new coronary revascularization in the TAVR + PCI group (HR: 5.38; 95% CI: 1.73-16.7). CONCLUSIONS In patients with severe AS and complex CAD, TAVR + PCI and SAVR + CABG were associated with similar rates of MACCE after a median follow-up period of 3 years, but TAVR + PCI recipients exhibited a higher risk for repeat coronary revascularization. Future trials are warranted. (J Am Coll Cardiol Intv 2021;14:2490-2499) (c) 2021 by the American College of Cardiology Foundation.
%K KEY WORDS aortic stenosis
%K coronary artery disease
%K surgical aortic valve replacement
%K transcatheter aortic valve replacement
%K Esc/eacts guidelines
%K European association
%K Stenosis
%K Outcomes
%K Surgery
%K Society
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