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Catheter versus surgical approach for the management of concomitant aortic stenosis and coronary artery disease: An inverse probability treatment weighting analysis - 25/01/23

Doi : 10.1016/j.acvd.2022.12.004 
Adèle Lérault a, Aurélien Villecourt a, Thibaud Decottignies-Dienne a, Sophie Tassan-Mangina a, Virginie Heroguelle a, Alessandro Di Cesare b, Sylvain Rubin b, Vito Giovanni Ruggieri b, Damien Metz a, Laurent Faroux a, c,
a Department of Cardiology, Reims University Hospital, 51092 Reims, France 
b Cardiac Surgery Department, Reims University Hospital, 51092 Reims, France 
c EA3801 HERVI, SFR CAP Santé, University of Reims Champagne Ardenne, 51100 Reims, France 

Corresponding author at: Department of Cardiology, Reims University Hospital, Avenue du General Koenig, 51092 Reims, France.Department of Cardiology, Reims University HospitalAvenue du General KoenigReims51092France
Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 25 January 2023

Highlights

Patients with concomitant AS and CAD can be treated by catheter or surgery.
Patients treated by catheter have a higher co-morbidity burden.
The surgical approach is associated with a higher rate of procedural complications.
Patients treated by catheter have similar late outcomes to those treated by surgery.

Le texte complet de cet article est disponible en PDF.

Summary

Background

Two therapeutic strategies are available when aortic stenosis and coronary artery disease coexist: a transcatheter approach, with percutaneous coronary intervention followed by transcatheter aortic valve replacement; and a surgical approach, consisting of surgical aortic valve replacement combined with coronary artery bypass graft.

Aim

We sought to compare the outcomes of these two strategies.

Methods

The study population consisted of 241 patients who benefited from aortic valve replacement and coronary revascularization (transcatheter, n=150; surgery, n=91).

Results

Patients in the transcatheter population were older (83.5 vs. 71.8years; P<0.001) and had a higher Logistic EuroSCORE (11.1% vs. 5.7%; P<0.001). At 30days postprocedure, patients who had surgery exhibited more life-threatening bleedings (12.1% vs 4.5%; P=0.034), acute kidney injury (12.1% vs. 1.3%; P<0.001) and atrial fibrillation (55.6% vs. 8.7%; P<0.001). After a median follow-up of 27months, the risk of major adverse cardiovascular or cerebrovascular events did not differ significantly between the two strategies (hazard ratio [HR] 1.41, 95% confidence interval [CI] 0.97–2.04; P=0.07), whereas estimated glomerular filtration rate<60mL/min (HR 2.22, 95% CI 1.58–3.12; P<0.001), peripheral artery disease (HR 2.00, 95% CI 1.37–2.91; P<0.001) and left ventricular ejection fraction<50% (HR 1.69, 95% CI 1.12–2.55; P=0.012) were associated with a negative prognosis.

Conclusions

In our study, patients with aortic stenosis and coronary artery disease treated by catheter were older and had a higher co-morbidity burden than those treated by surgery. The surgical strategy was associated with a higher rate of 30-day complications, but long-term outcomes were similar between the two strategies.

Le texte complet de cet article est disponible en PDF.

Keywords : Aortic stenosis, Coronary artery disease, Transcatheter aortic valve replacement, Percutaneous coronary intervention, Surgical aortic valve replacement

Abbreviations : AS, CABG, CAD, CI, eGFR, HR, IPTW, LVEF, MACCE, PAD, PCI, SAVR, TAVR


Plan


 Tweet: PCI+TAVR versus SAVR+CABG: higher rate of procedural complications associated with the surgical approach, but similar late outcomes. Twitter address: @LFX51.


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