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Søndergaard L, Popma JJ, Reardon MJ, Van Mieghem NM, Deeb GM, Kodali S, George I, Williams MR, Yakubov SJ, Kappetein AP, Serruys PW, Grube E, Schiltgen MB, Chang Y, Engstrøm T, Sorajja P, Sun B, Agarwal H, Langdon T, den Heijer P, Bentala M, O’Hair D, Bajwa T, Byrne T, Caskey M, Paulus B, Garrett E, Stoler R, Hebeler R, Khabbaz K, Scott Lim D, Bladergroen M, Fail P, Feinberg E, Rinaldi M, Skipper E, Chawla A, Hockmuth D, Makkar R, Cheng W, Aji J, Bowen F, Schreiber T, Henry S, Hengstenberg C, Bleiziffer S, Harrison JK, Hughes C, Joye J, Gaudiani V, Babaliaros V, Thourani V, Dauerman H, Schmoker J, Skelding K, Casale A, Kovac J, Spyt T, Seshiah P, Smith JM, McKay R, Hagberg R, Matthews R, Starnes V, O’Neill W, Paone G, García JMH, Such M, de la Tassa CM, Cortina JCL, Windecker S, Carrel T, Whisenant B, Doty J, Resar J, Conte J, Aharonian V, Pfeffer T, Rück A, Corbascio M, Blackman D, Kaul P, Kliger C, Brinster D, Teefy P, Kiaii B, Leya F, Bakhos M, Sandhu G, Pochettino A, Piazza N, de Varennes B, van Boven A, Boonstra P, Waksman R, Bafi A, Asgar A, Cartier R, Kipperman R, Brown J, Lin L, Rovin J, Sharma S, Adams D, Katz S, Hartman A, Al-Jilaihawi H, Crestanello J, Lilly S, Ghani M, Bodenhamer RM, Rajagopal V, Kauten J, Mumtaz M, Bachinsky W, Nickenig G, Welz A, Olsen P, Watson D, Chhatriwalla A, Allen K, Teirstein P, Tyner J, Mahoney P, Newton J, Merhi W, Keiser J, Yeung A, Miller C, Berg JT, Heijmen R, Petrossian G, Robinson N, Brecker S, Jahangiri M, Davis T, Batra S, Hermiller J, Heimansohn D, Radhakrishnan S, Fremes S, Maini B, Bethea B, Brown D, Ryan W, Kleiman N, Spies C, Lau J, Herrmann H, Bavaria J, Horlick E, Feindel C, Neumann FJ, Beyersdorf F, Binder R, Maisano F, Costa M, Markowitz A, Tadros P, Zorn G, de Marchena E, Salerno T, Chetcuti S, Labinz M, Ruel M, Lee JS, Gleason T, Ling F, Knight P, Robbins M, Ball S, Giacomini J, Burdon T, Applegate R, Kon N, Schwartz R, Schubach S, Forrest J, Mangi A. Comparison of a Complete Percutaneous Versus Surgical Approach to Aortic Valve Replacement and Revascularization in Patients at Intermediate Surgical Risk: Results From the Randomized SURTAVI Trial. Circulation 2019; 140:1296-1305. [PMID: 31476897 DOI: 10.1161/circulationaha.118.039564] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND For patients with severe aortic stenosis and coronary artery disease, the completely percutaneous approach to aortic valve replacement and revascularization has not been compared with the standard surgical approach. METHODS The prospective SURTAVI trial (Safety and Efficiency Study of the Medtronic CoreValve System in the Treatment of Severe, Symptomatic Aortic Stenosis in Intermediate Risk Subjects Who Need Aortic Valve Replacement) enrolled intermediate-risk patients with severe aortic stenosis from 87 centers in the United States, Canada, and Europe between June 2012 and June 2016. Complex coronary artery disease with SYNTAX score (Synergy Between PCI with Taxus and Cardiac Surgery Trial) >22 was an exclusion criterion. Patients were stratified according to the need for revascularization and then randomly assigned to treatment with transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR). Patients assigned to revascularization in the TAVR group underwent percutaneous coronary intervention, whereas those in the SAVR group had coronary artery bypass grafting. The primary end point was the rate of all-cause mortality or disabling stroke at 2 years. RESULTS Of 1660 subjects with attempted aortic valve implants, 332 (20%) were assigned to revascularization. They had a higher Society of Thoracic Surgeons risk score for mortality (4.8±1.7% versus 4.4±1.5%; P<0.01) and were more likely to be male (65.1% versus 54.2%; P<0.01) than the 1328 patients not assigned to revascularization. After randomization to treatment, there were 169 patients undergoing TAVR and percutaneous coronary intervention, 163 patients undergoing SAVR and coronary artery bypass grafting, 695 patients undergoing TAVR, and 633 patients undergoing SAVR. No significant difference in the rate of the primary end point was found between TAVR and percutaneous coronary intervention and SAVR and coronary artery bypass grafting (16.0%; 95% CI, 11.1-22.9 versus 14.0%; 95% CI, 9.2-21.1; P=0.62), or between TAVR and SAVR (11.9%; 95% CI, 9.5-14.7 versus 12.3%; 95% CI, 9.8-15.4; P=0.76). CONCLUSIONS For patients at intermediate surgical risk with severe aortic stenosis and noncomplex coronary artery disease (SYNTAX score ≤22), a complete percutaneous approach of TAVR and percutaneous coronary intervention is a reasonable alternative to SAVR and coronary artery bypass grafting. CLINICAL TRIAL REGISTRATION URL: https://www. CLINICALTRIALS gov. Unique identifier: NCT01586910.
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Affiliation(s)
- Lars Søndergaard
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark (L.S., T.E.)
| | - Jeffrey J. Popma
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | - Michael J. Reardon
- Department of Cardiovascular Surgery, Methodist DeBakey Heart and Vascular Center, Houston, TX (M.J.R.)
| | - Nicolas M. Van Mieghem
- Departments of Cardiology and Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands (N.M.V.M., A.P.K.)
| | - G. Michael Deeb
- Department of Cardiac Surgery, University of Michigan, Ann Arbor (G.M.D.)
| | - Susheel Kodali
- Department of Surgery, Columbia University Medical Center, New York (S.K., I.G.)
| | - Isaac George
- Department of Surgery, Columbia University Medical Center, New York (S.K., I.G.)
| | - Mathew R. Williams
- Departments of Medicine (Cardiology) and Cardiothoracic Surgery, NYU-Langone Medical Center, New York (M.R.W.)
| | - Steven J. Yakubov
- Department of Cardiology, OhioHealth Riverside Methodist Hospital, Columbus (S.J.Y.)
| | - Arie P. Kappetein
- Departments of Cardiology and Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands (N.M.V.M., A.P.K.)
- Structural Heart, Medtronic plc, Minneapolis, MN (A.P.K., M.B.S., Y.C.)
| | - Patrick W. Serruys
- International Centre for Circulatory Health, NHLI, Imperial College London, United Kingdom (P.W.S.)
| | - Eberhard Grube
- Department of Medicine II, Heart Center Bonn, Germany (E.G.)
| | | | - Yanping Chang
- Structural Heart, Medtronic plc, Minneapolis, MN (A.P.K., M.B.S., Y.C.)
| | - Thomas Engstrøm
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark (L.S., T.E.)
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