Clin Res Cardiol (2021). 10.1007/s00392-021-01933-9

Short- and intermediate-term mortality in women and men after surgical versus interventional revascularization and aortic valve replacement
M. Potratz1, V. Fortmeier1, P. Müller1, K. Friedrichs1, S. Scholtz1, J. Gummert2, V. Rudolph1, T. Gilis-Januszewski2, S. Bleiziffer2, T. K. Rudolph1
1Allgemeine und Interventionelle Kardiologie/Angiologie, Herz- und Diabeteszentrum NRW, Bad Oeynhausen; 2Klinik für Thorax- und Kardiovaskularchirurgie, Herz- und Diabeteszentrum NRW, Bad Oeynhausen;

Background: Patients with isolated aortic valve stenosis (AS) at intermediate and even low-risk benefit from an interventional treatment with Transcatheter Aortic Valve Implantation (TAVI) as compared to surgical aortic valve replacement (SAVR). Whether patients with concomitant coronary artery disease – present in almost 50% of them - have a better outcome with an interventional (PCI plus TAVI) or surgical (CABG plus SAVR) treatment strategy is still unclear.

Purpose: This study aims to analyze the differences in 30-days (short-term) and one-year (intermediate term) mortality in women and men with CAD and AS undergoing a surgical or catheter-based treatment.

Methods: All patients were enrolled at one tertiary center in Germany between 2016 and 2019. Whereas the surgical group consisted of 932 patients, the interventional cohort contained 360 patients as a result of setting a maximum time interval of 3 months between PCI and TAVR.

CABG+SAVR and PCI+TAVR cohorts were compared by using a propensity score analysis. Age, left ventricular function, EuroSCORE II and degree of CAD served as matching parameters. After matching the total cohort, 406 patients could be obtained. The matched female cohort consisted of 114 patients, the matched male cohort of 284 patients. As a primary endpoint all-cause mortality was analyzed at 30 days and one year after the procedure. Additionally, procedural and post-procedural outcome were compared.

Results: The TAVI cohort represented a low to intermediate risk population (EuroScore II of the total cohort: 3.82 [2.49-6.64] in CABG+SAVR vs 4.36 [2.59-7.12] in PCI+TAVR, p=0.38; women: 6.18 [3.43-8.6], p=0.279; men: 4.39 [2.83-8.82], p=0.279). Regarding the total cohort, no significant difference in 30-day mortality could be found between the surgical and interventional group (3.9% vs 2.5%; p=0.398). Whereas in the male cohort 30-days mortality was comparable between interventional and surgical treatment (2.1% vs 2.1%; p=1), in the female group the surgical treatment showed a trend towards higher mortality without reaching statistical significance (8.8% vs 3.5%; p=0.242). Additionally, one-year mortality did not differ in the three cohorts between CABG+SAVR and PCI+TAVR (total cohort: 11.3% vs 12.8%; p=0.648 women: 14% vs 10.5%; p=0.568; men: 11.3% vs 14.8%; p=0.378). The number of postprocedural permanent pacemaker implantations was statistically higher after TAVR plus PCI (total cohort: 7.4% vs 15.3%; p=0.012; women: 7% vs 19.3%; p=0.052; men: 8.5% vs 19%; p=0.01). Furthermore, a significantly longer length of hospital stay was reported for the surgical cohort (total cohort: 13 [11-17] vs 11 [9-15]; p=0; women: 14 [12-18] vs 12 [10.5-15.5]; p=0.019; men: 13 [11-15] vs 11 [9-15]; p=0).

Conclusion: Regarding short and intermediate term mortality no significant difference could be shown in patients with AS and CAD after surgical versus interventional revascularization and aortic valve replacement. Subsequently, an interventional approach might be a legitimate alternative to CABG+SAVR in these patients.


https://dgk.org/kongress_programme/ht2021/P682.htm