Characteristics of patients qualified for aortic valve replacement combined with coronary artery bypass grafting surgery in the era of transcatheter aortic valve implantation dominance study (CAPTOR study).
Source: PubMed, NCBI / U.S. National Library of Medicine
The growing use of transcatheter aortic valve implantation (TAVI) has significantly changed treatment strategies for patients with aortic stenosis (AS), especially those with coexisting coronary artery disease (CAD). However, the impact of this shift on surgical aortic valve replacement combined with coronary artery bypass grafting (AVR + CABG) remains unclear. This study aimed to evaluate temporal trends, clinical characteristics, perioperative outcomes, and 5-year survival in patients undergoing AVR + CABG in the context of increasing TAVI adoption in Poland between 2014 and 2023. This retrospective, multicenter cohort study used data from the Polish National Cardiac Surgery Database. A total of 65,085 patients qualified for aortic valve intervention between 2014 and 2023 were analyzed. Baseline characteristics, procedural details, complication rates, and 5-year survival (Kaplan-Meier method) were assessed. AVR + CABG trends were compared to TAVI volumes over time. The proportion of patients undergoing AVR + CABG decreased by 25% over the study period, while TAVI procedures increased fivefold. AVR + CABG patients became younger and predominantly male, with higher prevalence of hypertension and hyperlipidemia but improved functional status. Despite longer cross-clamp times and changes in prosthesis size, perioperative mortality and complication rates remained stable. Mid-term survival was not significantly affected. The growing use of percutaneous coronary intervention (PCI)
Abstract
The growing use of transcatheter aortic valve implantation (TAVI) has significantly changed treatment strategies for patients with aortic stenosis (AS), especially those with coexisting coronary artery disease (CAD). However, the impact of this shift on surgical aortic valve replacement combined with coronary artery bypass grafting (AVR + CABG) remains unclear. This study aimed to evaluate temporal trends, clinical characteristics, perioperative outcomes, and 5-year survival in patients undergoing AVR + CABG in the context of increasing TAVI adoption in Poland between 2014 and 2023. This retrospective, multicenter cohort study used data from the Polish National Cardiac Surgery Database. A total of 65,085 patients qualified for aortic valve intervention between 2014 and 2023 were analyzed. Baseline characteristics, procedural details, complication rates, and 5-year survival (Kaplan-Meier method) were assessed. AVR + CABG trends were compared to TAVI volumes over time. The proportion of patients undergoing AVR + CABG decreased by 25% over the study period, while TAVI procedures increased fivefold. AVR + CABG patients became younger and predominantly male, with higher prevalence of hypertension and hyperlipidemia but improved functional status. Despite longer cross-clamp times and changes in prosthesis size, perioperative mortality and complication rates remained stable. Mid-term survival was not significantly affected. The growing use of percutaneous coronary intervention (PCI) with TAVI likely influenced these trends. Despite declining volumes, AVR + CABG remains an effective and safe option for selected patients. In the evolving landscape of valve disease treatment, multidisciplinary Heart Team decision-making and further comparative studies are essential.