Transcatheter versus surgical treatment in aortic stenosis with coronary artery disease: A meta-analysis of time-to-event data on 162,305 patients

Authors

Ahmed Emara, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Mohamed Emara, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Ahmed Farid Gadelmawla, Faculty of Medicine, Menoufia University, Menoufia, Egypt; Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA.
Mohamed R. Murad, Faculty of Medicine, Al-Azhar University, Cairo, Egypt; Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA.
Heba Aboeldahab, Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA; Clinical Research Department, El-Gomhoria General Hospital, Ministry of health and population, Alexandria, Egypt.
Mohamed S. Elgendy, Faculty of Medicine, Tanta University, Tanta, Egypt.
Mohamed Sabri Hassanin, Faculty of Medicine, Al-Azhar University, Cairo, Egypt; Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA.
Mohamed A. Aldemerdash, Faculty of Medicine, Sohag University, Sohag, Egypt.
Ali M. Othman, Faculty of Medicine, Kafr El Sheik University, Kafr El Sheik, Egypt.
Mohamed Khaled, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Abdalhakim Shubietah, Advocate Health - MidwestFollow
Abdalrahman Assaassa, Department of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Vinayak N. Bapat, Department of Cardiac Surgery, Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA. Electronic address: Vinayak.Bapat@allina.com.

Recommended Citation

Emara A, Emara M, Gadelmawla AF, et al. Transcatheter versus surgical treatment in aortic stenosis with coronary artery disease: A meta-analysis of time-to-event data on 162,305 patients. Heart Lung. 2026;75:184-197. doi:10.1016/j.hrtlng.2025.09.018

Affiliations

Advocate Illinois Masonic Medical Center

Abstract

Background: Severe aortic stenosis (AS) often coexists with coronary artery disease (CAD), present in about 50 % of patients undergoing valve intervention. Surgical aortic valve replacement (SAVR) with coronary artery bypass graft (CABG) has been the traditional standard, providing revascularization and durability, whereas transcatheter aortic valve replacement (TAVR) with percutaneous coronary intervention (PCI) offers a less invasive option. PCI + TAVR may lower perioperative risk, but SAVR + CABG may confer superior survival, with conflicting evidence.

Objectives: This meta-analysis of time-to-event data aimed to compare PCI + TAVR with CABG + SAVR in patients with concomitant AS and CAD.

Methods: We systematically searched PubMed, Web of Science, Scopus, and Cochrane databases up to March 2025. Individual patient data (IPD) were reconstructed from published Kaplan-Meier curves to estimate hazard ratios (HRs) for all-cause mortality. Dichotomous outcomes were analyzed using risk ratios (RR) with 95 % confidence intervals (CI).

Results: Fifteen studies including 162,305 patients were analyzed. PCI + TAVR was associated with higher all-cause mortality at 48 months (HR 1.29, 95 % CI 1.23-1.35, p < 0.001), but lower in-hospital acute kidney injury (RR 0.37, 95 % CI 0.21-0.66, p = 0.0007), short-term (≤30 days) major adverse cardiovascular events (RR 0.67, 95 % CI 0.50-0.91, p = 0.0093), and new-onset atrial fibrillation (RR 0.23, 95 % CI 0.17-0.32, p < 0.0001). Conversely, long-term (>30 days) myocardial infarction risk was higher (RR 1.61, 95 % CI 1.08-2.39, p = 0.01).

Conclusions: PCI+TAVR was associated with higher mortality or adverse event rates compared to CABG+SAVR, but lower perioperative complications. High-quality randomized trials are warranted to confirm these findings.

Type

Article

PubMed ID

41067128