TAVI plus PCI versus SAVR plus CABG: Long-term outcome of a multicentre-registry

Background In elderly patients with severe aortic stenosis (AS), concomitant coronary artery disease (CAD) is common. Escpecially for intermediate-risk patients eligible for both interventional and surgical treatment, long-term benefit of either approach remains unclear. Objectives To compare long-term outcomes of TAVI + PCI versus SAVR + CABG in intermediate-risk AS-CAD patients (logistic EuroSCORE 10–20%, EuroSCORE II 4–9%). Methods This retrospective multicentre study included 366 patients treated between 2012 and 2020: 211 underwent TAVI + PCI and 155 received SAVR + CABG. The primary endpoint was all-cause mortality up to three years; secondary outcomes followed VARC-3 criteria. Results Mortality rates were similar at 30 days (4.8% vs. 8.4%, p = 0.16), six months (12.4% each), one year (18.1% vs. 15.7%) and two years (24.9% vs. 20.1%). At three years, mortality was higher after TAVI + PCI (37.1% vs. 25.5%, p = 0.02), though CAD complexity was greater in the SAVR + CABG group (SYNTAX Score 22.2 vs. 15.9, p < 0.001). TAVI + PCI patients were older (81.1 vs. 78.5 years, p < 0.001), but surgical risk was comparable (EuroSCORE II 6.4% vs. 6.2%). Surgical patients experienced more complications, including delirium, stroke, acute kidney injury, major bleedings and transfusion needs. After propensity score matching (154 patients per group), 3-year mortality no longer differed significantly (33.8% vs. 25.9%, p = 0.14). Conclusion Both TAVI + PCI and SAVR + CABG yield comparable long-term outcomes in intermediate-risk AS-CAD patients. Although early complications were more common with surgery, there was a trend towards improved long-term survival.