Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w
TAVI plus PCI versus SAVR plus CABG - longterm outcome of a two-center-registry
C. Kupatt1, A. Stundl1, A. Prinzing2, H. Seoudy3, L. Preuss1, R. Thalmann1, H. Ruge2, R. Lange2, M. Krane2, D. Frank4
1Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar der Technischen Universität München, München; 2Deutsches Herzzentrum München, München; 3Klinik für Innere Medizin III, Schwerpunkt Kardiologie und Angiologie, Universitätsklinikum Schleswig-Holstein, Kiel; 4Med. Klinik III / Kardiologie, Angiologie, Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Kiel;

Background: Significant obstructive coronary artery disease (CAD) is frequently seen in patients with severe aortic valve stenosis (AS), and even more in elderly patients undergoing TAVI with additional comorbidities. Current guidelines recommend myocardial revascularization of coronary lesions greater > 50% at the time of SAVR. On the other hand, coronary stenosis ≥ 70% is recommended to be treated via percutaneous coronary intervention (PCI) prior TAVI (ESC/EACTS Guidelines 2022). Especially for AS patients being identified at “intermediate” risk indicated by surgical risk scores, who are eligible for surgical or interventional options, longterm benefit of either treatment strategy is unclear

Aims: The aim of the present study was to assess longterm outcome of either  treatment option (TAVI+PCI vs. SAVR+CABG) in intermediate risk AS patients (logistic EuroSCORE 10-20%) and to develop a treatment algorithm for this patient subset.

Methods: This 2-centre retrospective study included 236 patients in total who underwent either interventional (TAVI+PCI, n=142) or surgical treatment (SAVR+CABG, n=94). All-cause mortality up to 1095 days after aortic valve treatment was the primary endpoint. Other outcomes were recorded according to the VARC-2 criteria.

Results: The TAVI+PCI group was older (82±6 vs. 78±5 years) and sicker (EuroScore II 7.1 vs. 5.9, p=0.009) than the SAVR+CABG group, but did not differ with regard to cardiac risk factors nor coronary artery disease distribution and previous interventional or surgical treatment frequencies.  The Syntax score was higher in the SAVR+CABG group (19.0 vs. 14.0, p<0.001), as was the procedure time (296 vs.  52 min, p<0.001).

The earlier mortality rates did not differ between TAVI+PCI and SAVR+CABG (6.3 vs. 9.6%), nor did the 6months-, 1-year (20.4vs.13.8%)  or 2-year mortalities (26.8 vs. 19.1%). Of note, at 3 years, SAVR+CABG mortality was significantly lower (19.1%) than TAVI+PCI (34.5%, p=0.007).  


 Being aware of the significant differences of both groups mentioned above, in a next step, we conducted a propensity-score analyses of 92 matched surgical and interventional patients. Again, a significant difference in survival probability was detected 3 years after treatment (p=0.02).

 
  

Conclusion: During an early and intermediate phase, comparable results could be achieved between aortic stenosis patients treated either by interventional- or surgical-only means. For long-term outcome (3 years), however, SAVR+CABG treatment might provide a survival benefit.
https://dgk.org/kongress_programme/jt2023/aP502.html