Outcomes of surgical aortic valve replacement with coronary artery bypass grafting versus transcatheter aortic valve replacement with percutaneous coronary intervention

Background Aortic stenosis (AS) often coexists with coronary artery disease (CAD). Although transcatheter aortic valve replacement (TAVR) with percutaneous coronary intervention (PCI) is frequently performed, comparative data with surgical aortic valve replacement (SAVR) with coronary artery bypass grafting (CABG) remain limited. This study compared outcomes of TAVR plus PCI versus SAVR plus CABG in patients with severe AS and CAD. Methods Data were obtained from the TriNetX Research Network, a large real-world retrospective database. Patients undergoing TAVR plus PCI or SAVR plus CABG between January 2015 to December 2022 were identified. After propensity score matching, 2483 patients were included in each group. Thirty-day outcomes included all-cause mortality, stroke, and permanent pacemaker (PPM) implantation. In addition, all-cause mortality at 1 and 3 years was determined. Results At 30 days, SAVR plus CABG was associated with higher all-cause mortality (4.2% vs 2.7%; p = 0.005) and higher incidence of stroke (5.5% vs 3.8%, p = 0.003) compared to TAVR plus PCI; however, PPM was lower in SAVR plus CABG (5.2% vs. 8.4%; p < 0.001). At 1-year, all-cause mortality was similar between SAVR plus CABG and TAVR plus PCI (10.4% vs. 11.1% [ p = 0.70], respectively). At 3 years, SAVR plus CABG demonstrated lower all-cause mortality compared with TAVR plus PCI (18.7% vs 26.2%; p < 0.001). Conclusion In patients with severe AS and CAD, SAVR with CABG is associated with higher short term all-cause mortality and stroke with lower PPM implantation compared to TAVR with PCI. Despite worse early outcomes, SAVR with CABG demonstrated superior long-term survival at 3 years.