Combined treatment for coronary artery disease and aortic valve stenosis

Objectives: This study evaluated early and midterm prognostic outcomes of transcatheter aortic valve implantation (TAVI) in combination with percutaneous coronary intervention (PCI) compared with surgical aortic valve replacement (SAVR) plus coronary artery bypass grafting (CABG) in patients with severe aortic stenosis and anatomically complex coronary artery disease (CAD). Methods: Between 2010 and 2020, 1232 consecutive patients underwent TAVI with PCI or SAVR with CABG at a tertiary referral center. Eligibility required the presence of complex CAD (SYNTAX I score > 22). Propensity score matching (1:1) generated 76 well-balanced patient pairs. The primary endpoint was early mortality; secondary endpoints included major adverse cardiac and cerebrovascular events (MACCE) and midterm mortality. Results: Matched cohorts exhibited intermediate operative risk (STS score: 3.0 ± 1.7 vs. 3.4 ± 1.2; EuroSCORE II: 6.89 ± 4.3 vs. 7.41 ± 4.7). No significant intergroup differences were observed regarding all-cause mortality (p = 0.262), ischemic stroke (p = 0.527), or myocardial infarction (p = 0.474) during follow-up. Similarly, reintervention rates did not differ (p = 0.515, HR: 2.1, 95% CI: 0.282–15.200). MACCE (p = 0.061, HR: 1.8, 95% CI: 0.938–3.509) and new pacemaker implantation (p = 0.087, HR: 0.5, 95% CI: 0.187–1.089) occurred numerically more frequently in the TAVI + PCI group without statistical significance. Prosthetic valve regurgitation > Grade II was less common in SAVR + CABG, whereas mean transvalvular gradients favored TAVI + PCI. Conclusion: In patients with severe aortic stenosis and advanced CAD, TAVI + PCI yielded overall outcomes comparable to SAVR + CABG. However, the surgical strategy demonstrated superiority in terms of MACCE incidence and device-related conduction disturbances. Prospective randomized evidence is imperative to optimize patient selection and refine guideline-directed decision-making in this complex cohort.