Outcomes of Complete Transcatheter versus Complete Surgical Treatment in Patients with Severe Aortic Valve Stenosis and Concomitant Coronary Artery Disease

Background: There are many studies comparing surgical (SAVR) and transcatheter (TAVR) aortic valve replacement, but in most cases patients with complex coronary artery disease (CAD) were excluded from the trials. Aim: To evaluate clinical outcomes and echocardiography parameters of TAVR and percutaneous coronary intervention (PCI) compared with SAVR and coronary arteries bypass grafting (CABG) procedures in patients with concomitant aortic stenosis (AS) and CAD. Methods: Retrospective study involved 200 patients with significant AS with CAD, requiring prosthetic valve implantation and interventional or surgical CAD treatment. Data collected were epidemiological data, comorbidities, and echocardiography parameters before the aortic valve replacement and within a month after the replacement, the type of prosthesis, and early complications of the procedure and mortality rate for four years. Results: A total of 200 patients who underwent TAVR + PCI (100 patients) or SAVR + CABG (100 patients) were included. After 30 days follow-up period, there was no significant difference between groups for all causes mortality (3% vs. 9%, p=0.134). A new onset atrial fibrillation (8% vs. 34 %, p<0.001), acute kidney injury (0% vs. 7%, p=0.014) and red blood cells transfusions (10% vs. 24%, p=0.008) were significantly lower in patients undergoing TAVR + PCI compared to SAVR + CABG. Postoperative peak aortic valve gradient was significantly higher in the SAVR group (25.77 ± 1.39 mmHg) compared to patients treated with TAVR (15.56 ± 0.66 mmHg, p=0.002). Mild or greater paravalvular leakage (PVL) was more frequent in the TAVR group (43%) than in the SAVR group (22%, p < 0.001). Mortality rate for four years was assessed – there was a tendency of higher mortality rates in TAVR + PCI group, but this difference was not statistically significant. Conclusions: Compared to SAVR + CABG surgery, TAVR + PCI procedure, had lower rates for acute kidney injury (AKI), new onset atrial fibrillation (NOAF) and red blood cells (RBC) transfusions following 30 days analysis. Postoperative valve performance data showed that the peak gradient was lower in TAVR + PCI group, while the rates of significant aortic regurgitation were higher in this group. Long-term mortality rates tend to be higher in TAVR + PCI group, but this difference was not statistically significant.