Complete transcatheter versus surgical approach stenosis with coronary artery disease: A systematic and meta-analysis

Objective: This meta-analysis aimed to evaluate outcomes of transcatheter valve replacement (TAVR) with percutaneous coronary intervention (PCI) surgical aortic valve replacement (SAVR) with coronary artery bypass grafting (CABG). Methods: The MEDLINE, EMBASE, and Cochrane Library databases were searched through November 2021 to identify studies comparing TAVR + PCI and SAVR CABG for severe aortic stenosis with concurrent coronary artery disease. Outcomes of interest were all -cause mortality, repeat coronary intervention, spitalization, myocardial infarction, and stroke during follow-up, and periprocedural outcomes. Results: Two randomized controlled trials and 6 observational studies including total of 104,220 patients (TAVR + PCI, n = 5004; SAVR + CABG, n = 99,216) included. The weighted mean follow-up period was 30.2 months. TAVR + associated with greater all -cause mortality and coronary reintervention follow-up period (hazard ratio, 1.35; 95% confidence interval [CI], 1.11-1.65; P = .003, hazard ratio, 4.14; 95% CI, 1.74-9.86; P = .001, respectively), 30-day manent pacemaker implantation rate (odds ratio [OR], 3.79; 95% CI, 1.61-8.95; P = .002), and periprocedural vascular complications (OR, 6.97; 95% CI, 26.30; P = .004). In contrast, TAVR + PCI was associated with a lower 30-day acute kidney injury (OR, 0.32; 95% CI, 0.20-0.50; P = .0001). Rehospitalization, myocardial infarction, stroke during follow-up, and other periprocedural comes including 30-day mortality were similar in both groups. Conclusions: In patients with severe aortic stenosis and coronary artery disease, TAVR + PCI was associated with greater all -cause mortality at follow-up compared with SAVR + CABG. Heart Team approach to assess TAVR candidacy remains imperative. (J Thorac Cardiovasc Surg 2024;167:1305-13)