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<p>Aortic stenosis (AS) and coronary artery disease (CAD) frequently coexist in elderly patients. Surgical aortic valve replacement (SAVR) with coronary artery bypass grafting (CABG) has been the standard treatment. However, transcatheter aortic valve replacement (TAVR) combined with percutaneous coronary intervention (PCI) currently offers a less invasive alternative. This study describes in-hospital and functional outcomes in elderly patients with AS and CAD undergoing TAVR + PCI or SAVR + CABG, and evaluates procedural volume influence. This retrospective cohort study analyzed 12,393 patients from the Japanese Registry of All Cardiac and Vascular Diseases–Diagnosis Procedure Combination database (2012–2022) who underwent TAVR + PCI (n = 1,487) or SAVR + CABG (n = 10,906) during hospitalization for AS. The primary endpoint was in-hospital mortality rate. Secondary outcomes included functional recovery, assessed using the Barthel Index (BI). Multivariate logistic regression models were adjusted for demographics, comorbidities, and procedural volume. Patients in the TAVR + PCI group were older (85.1 vs. 75.5&#xa0;years) and had higher frailty. However, in-hospital mortality was lower in TAVR + PCI (3.3% vs. 5.1%, p = 0.002), with greater improvements in BI scores at discharge (+ 5.9 vs. − 1.9, p &lt; 0.001). SAVR + CABG outcomes improved significantly at high-volume Centers (adjusted OR for mortality in the lowest vs. highest quartile: 2.067, p &lt; 0.001). In contrast, TAVR outcomes were consistent regardless of institutional procedural volume. TAVR + PCI was associated with favorable short-term outcomes and functional recovery in elderly AS patients with CAD, despite older age and greater frailty. Institutional experience strongly influences SAVR outcomes, but appears less critical in TAVR, suggesting that TAVR can be safely performed at more hospitals.</p> Graphical Abstract <p></p>

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Differential impact of institutional procedural volume on outcomes of transcatheter and surgical strategies for concomitant aortic stenosis and coronary artery disease: a nationwide registry study

  • 期刊论文

  • 发表日期：

    2026年6月30日

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  • Kensuke Takagi,
  • Kentaro Mitsui,
  • Yoko Sumita,
  • Koshiro Kanaoka,
  • Yoshihiro Miyamoto,
  • Satsuki Fukushima,
  • Kazuhiro Yamamoto,
  • Teruo Noguchi

摘要

Aortic stenosis (AS) and coronary artery disease (CAD) frequently coexist in elderly patients. Surgical aortic valve replacement (SAVR) with coronary artery bypass grafting (CABG) has been the standard treatment. However, transcatheter aortic valve replacement (TAVR) combined with percutaneous coronary intervention (PCI) currently offers a less invasive alternative. This study describes in-hospital and functional outcomes in elderly patients with AS and CAD undergoing TAVR + PCI or SAVR + CABG, and evaluates procedural volume influence. This retrospective cohort study analyzed 12,393 patients from the Japanese Registry of All Cardiac and Vascular Diseases–Diagnosis Procedure Combination database (2012–2022) who underwent TAVR + PCI (n = 1,487) or SAVR + CABG (n = 10,906) during hospitalization for AS. The primary endpoint was in-hospital mortality rate. Secondary outcomes included functional recovery, assessed using the Barthel Index (BI). Multivariate logistic regression models were adjusted for demographics, comorbidities, and procedural volume. Patients in the TAVR + PCI group were older (85.1 vs. 75.5 years) and had higher frailty. However, in-hospital mortality was lower in TAVR + PCI (3.3% vs. 5.1%, p = 0.002), with greater improvements in BI scores at discharge (+ 5.9 vs. − 1.9, p < 0.001). SAVR + CABG outcomes improved significantly at high-volume Centers (adjusted OR for mortality in the lowest vs. highest quartile: 2.067, p < 0.001). In contrast, TAVR outcomes were consistent regardless of institutional procedural volume. TAVR + PCI was associated with favorable short-term outcomes and functional recovery in elderly AS patients with CAD, despite older age and greater frailty. Institutional experience strongly influences SAVR outcomes, but appears less critical in TAVR, suggesting that TAVR can be safely performed at more hospitals.

Graphical Abstract