RT Journal Article
T1 Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Complex Coronary Artery Disease
A1 Alperi, Alberto
A1 Mohammadi, Siamak
A1 Campelo-Parada, Francisco
A1 Munoz-Garcia, Erika
A1 Nombela-Franco, Luis
A1 Faroux, Laurent
A1 Veiga, Gabriela
A1 Serra, Vicenc
A1 Fischer, Quentin
A1 Pascual, Isaac
A1 Asmarats, Luis
A1 Gutierrez, Enrique
A1 Regueiro, Ander
A1 Vilalta, Victoria
A1 Ribeiro, Henrique B.
A1 Matta, Anthony
A1 Munoz-Garcia, Antonio
A1 Armijo, German
A1 Metz, Damien
A1 de la Torre Hernandez, Jose M.
A1 Rodenas-Alesina, Eduard
A1 Urena, Marina
A1 Moris, Cesar
A1 Arzamendi, Dabit
A1 Perez-Fuentes, Pedro
A1 Fernandez-Nofrerias, Eduard
A1 Campanha-Borges, Diego Carter
A1 Mesnier, Jules
A1 Voisine, Pierre
A1 Dumont, Eric
A1 Kalavrouziotis, Dimitri
A1 Rodes-Cabau, Josep
K1 KEY WORDS aortic stenosis
K1 coronary artery disease
K1 surgical aortic valve replacement
K1 transcatheter aortic valve replacement
K1 Esc/eacts guidelines
K1 European association
K1 Stenosis
K1 Outcomes
K1 Surgery
K1 Society
AB 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.
PB Elsevier science inc
SN 1936-8798
YR 2021
FD 2021-11-15
LK https://hdl.handle.net/10668/26865
UL https://hdl.handle.net/10668/26865
LA en
DS RISalud
RD Apr 17, 2025