Coronary revascularization during treatment of severe aortic stenosis: A meta-analysis of the complete percutaneous approach (PCI plus TAVR) versus the complete surgical approach (CABG plus SAVR)

Autor: Alexandru Burlacu, Bogdan Artene, Iolanda Valentina Popa, Alberto Emanuel Bacusca, Grigore Tinica, Andrei Tarus
Rok vydání: 2020
Předmět:
Pulmonary and Respiratory Medicine
Male
Risk
medicine.medical_specialty
Time Factors
medicine.medical_treatment
Coronary Artery Disease
030204 cardiovascular system & hematology
Revascularization
Severity of Illness Index
Coronary artery disease
Transcatheter Aortic Valve Replacement
03 medical and health sciences
0302 clinical medicine
Percutaneous Coronary Intervention
Aortic valve replacement
Valve replacement
Internal medicine
medicine
Humans
cardiovascular diseases
Myocardial infarction
Coronary Artery Bypass
Aged
Aged
80 and over
Heart Valve Prosthesis Implantation
business.industry
Percutaneous coronary intervention
Aortic Valve Stenosis
medicine.disease
Stenosis
Treatment Outcome
030228 respiratory system
Aortic Valve
Conventional PCI
Cardiology
Surgery
Female
Cardiology and Cardiovascular Medicine
business
Zdroj: Journal of cardiac surgeryREFERENCES. 35(8)
ISSN: 1540-8191
Popis: Background The management of patients with coexisting severe aortic stenosis (AS) and coronary artery disease (CAD) is still facing a great deal of uncertainty when it comes to choosing between the entire surgical versus the complete percutaneous approaches, after accurately balancing risks versus outcomes. Aim To evaluate clinical outcomes and mortality of transcatheter aortic valve replacement (TAVR) plus percutaneous coronary intervention (PCI) compared with surgical aortic valve replacement (SAVR) plus coronary arteries bypass grafting (CABG) procedures in patients with concomitant AS and CAD. Methods Electronic databases of PubMed, EMBASE, and SCOPUS were searched for relevant articles assessing outcome parameters of interest. The study endpoints were the rate of overall myocardial infarction and stroke within 30 days and the rate of 30-day mortality and 2-year mortality between patients with TAVR/PCI and those with SAVR/CABG. Results Random-effect meta-analysis did not reveal any significant difference between 30-day safety outcomes: myocardial infarction (TAVR/PCI vs SAVR/CABG: odds ratio [OR]: 0.52; 95% confidence interval [CI]: 0.20-1.33; I2 = 0%), stroke (TAVR/PCI vs SAVR/CABG: OR: 0.88; 95% CI: 0.45-1.73; I2 = 0%). No significant difference in 30-day mortality (OR: 0.72; 95% CI: 0.43-1.21; I2 = 0%) and 2-year mortality (OR: 1.50; 95% CI: 0.77-2.94; I2 = 81%) rate was noted between patients with TAVR/PCI and those with SAVR/CABG. Conclusions When comparing the total percutaneous and total surgical treatment, no significant difference in short-term safety outcomes or early and late mortality was observed. More evidence is needed to guide the clinical decision.
Databáze: OpenAIRE
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