Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Complex Coronary Artery Disease
| Autor: | Dabit Arzamendi, Laurent Faroux, José M. de la Torre Hernández, Marina Urena, Luis Nombela-Franco, Dimitri Kalavrouziotis, Ander Regueiro, Erika Muñoz-García, Jules Mesnier, Damien Metz, Siamak Mohammadi, Josep Rodés-Cabau, Eduard Fernandez-Nofrerias, César Morís, Enrique Gutiérrez, Luis Asmarats, Quentin Fischer, Henrique Barbosa Ribeiro, Francisco Campelo-Parada, Eduard Rodenas-Alesina, Vicenç Serra, Victoria Vilalta, Pedro Perez-Fuentes, Isaac Pascual, Antonio J. Muñoz-García, Alberto Alperi, Pierre Voisine, Anthony Matta, Eric Dumont, German Armijo, Diego Carter Campanha-Borges, Gabriela Veiga |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Coronary Artery Disease Coronary artery disease Transcatheter Aortic Valve Replacement Percutaneous Coronary Intervention Aortic valve replacement Valve replacement Risk Factors Internal medicine medicine Humans KEY WORDS aortic stenosis Myocardial infarction cardiovascular diseases Stroke Heart Valve Prosthesis Implantation business.industry Percutaneous coronary intervention Aortic Valve Stenosis medicine.disease Cardiac surgery Treatment Outcome Aortic Valve Conventional PCI Cardiology transcatheter aortic valve replacement Cardiology and Cardiovascular Medicine business coronary artery disease surgical aortic valve replacement |
| Zdroj: | JACC-Cardiovascular Interventions r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau instname JACC-CARDIOVASCULAR INTERVENTIONS r-IGTP. Repositorio Institucional de Producción Científica del Instituto de Investigación Germans Trias i Pujol |
| ISSN: | 1936-8798 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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