Comparative Strategies for Aortic Stenosis and Coronary Disease: Insights on TAVR and SAVR

A pooled time-to-event meta-analysis found similar long-term mortality for TAVR+PCI and SAVR+CABG in patients with severe aortic stenosis and concomitant coronary artery disease—a finding that reframes the procedural risk–benefit discussion.

Previously, choice often hinged on presumed survival advantage for one pathway; the pooled evidence now places survival parity at the center, shifting emphasis toward individual anatomy, completeness of revascularization, frailty, and anticipated valve durability when weighing options between percutaneous and surgical-first strategies.

The meta-analysis used time-to-event synthesis by reconstructing and pooling Kaplan–Meier curves to compare all-cause mortality and major adverse cardiovascular events (MACE) across strategies. Time-to-event pooling improves temporal comparability versus single-timepoint cross-sections; within these cohorts, pooled estimates did not demonstrate a clear mortality or MACE advantage for either strategy.

Pooled secondary analyses assessed rehospitalization and peri-procedural or early stroke. Results were inconsistent across studies and lacked a uniform directional signal favoring one approach. Where between-study heterogeneity emerged, pooled estimates were inconclusive.

Coronary lesion complexity and the likelihood of achieving complete revascularization remain pivotal determinants. Valve anatomy, vascular access, surgical risk, and frailty also inform feasibility and tolerance of transcatheter versus surgical approaches.