Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Complex Coronary Artery Disease.
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Alperi Alberto, Mohammadi Siamak, Campelo-Parada Francisco, Munoz-Garcia Erika, Nombela-Franco Luis, Faroux Laurent, Veiga Gabriela, Serra Vicenç, Fischer Quentin, Pascual Isaac, Asmarats Luis, Gutiérrez Enrique, Regueiro Ander, Vilalta Victoria, Ribeiro Henrique B, Matta Anthony, Munoz-Garcia Antonio, Armijo German, Metz Damien, De la Torre Hernandez Jose M, Rodenas-Alesina Eduard, Urena Marina, Moris Cesar, Arzamendi Dabit, Perez-Fuentes Pedro, Fernandez-Nofrerias Eduard, Campanha-Borges Diego Carter, Mesnier Jules, Voisine Pierre, Dumont Eric, Kalavrouziotis Dimitri, Rodés-Cabau Josep
Аннотация
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 (SYNTAX [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 cerebrovascular 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.