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

Background: Coronary artery disease (CAD) is frequently diagnosed in patients with aortic valve stenosis. Treatment options include interventional and surgical approaches. We therefore analyzed short-term outcomes of patients undergoing either staged percutaneous coronary intervention and transcatheter aortic valve implantation (PCI + TAVI) or coronary artery bypass grafting with simultaneous aortic valve replacement (CABG + AVR).

Method: From all patients treated since 2017, we retrospectively identified 237 patients undergoing TAVI within 6 months since PCI and 241 patients undergoing combined CABG + AVR surgery. Short-term outcomes including mortality rates were extracted from our institutional database. Propensity score matching (PSM) was performed to control for differences regarding demographic variables and risk scores resulting in 101 matched pairs.

Results: In the total cohort, patients in the PCI + TAVI group were older compared with CABG + AVR patients (81.4 ± 3.6 vs. 71.9 ± 4.9 years; p < 0.001) with a lower overall mortality at 30 days for PCI + TAVI patients (2.1 vs. 7.8%; p = 0.012). PSM cohort was balanced for PCI + TAVI and CABG + AVR groups according to demographic variables (age: 77.2 ± 3.7 vs. 78.5 ± 2.7 years; p = 0.141) and EuroSCORE II (6.2 vs. 7.6%; p = 0.297). At 30 days, mortality was 1% in the PCI + TAVI group and 4.9% in the CABG + AVR group (p = 0.099). ICU and in-hospital stays were shorter for PCI + TAVI patients (1 [1–4] vs. 3 [1–6]* days; p = 0.066) and (9 [5–23] vs. 13 [11–17]* days; p < 0.001). Conversion to open heart surgery was necessary in 2% in the PCI + TAVI group and re-thoracotomy was necessary in 7.9% in the CABG + AVR group (p = 0.035). The Need for pacemaker implantation (6.9 vs. 4.1%; p = 0.010) and the incidence of moderate to severe paravalvular leak (4.9 vs. 0%; p = 0.027) were higher in the PCI + TAVR group. There were no relevant differences in postoperative cerebrovascular events, peripheral vascular complications or acute renal failure. All continuous variables are described as mean (SD) except those noted * are described as median (IQR) due to non-normal distribution.

Conclusion: Combined surgical and staged interventional approaches show different short-term results regarding mortality and incidences of in-hospital-complications; however, long-term results are necessary to guide decision making for patients with CAD and aortic valve stenosis.

Publication History

Article published online:
03 February 2022