Abstract
OBJECTIVES: Transcatheter aortic valve implantation (TAVI) has replaced combined coronary artery bypass grafting (CABG) and surgical aortic valve replacement (SAVR) as the standard treatment for elderly patients with severe coronary artery disease (CAD) and aortic valve stenosis (AS). However, the long-term outcomes of the surgical approaches in the pre-TAVI era need revisiting. This study evaluated the short- and long-term outcomes of combined SAVR and CABG in elderly patients during the pre-TAVI era. MATERIALS: This retrospective data analysis evaluated patients aged ≥ 70 years who underwent combined SAVR and CABG between 2005 and 2014. METHODS: Short-term outcomes, including in-hospital mortality, stroke, respiratory failure and acute kidney injury, and long-term outcomes such as all-cause mortality, cardiac mortality, and major adverse cardiac and cerebrovascular events (MACCE), were assessed. RESULTS: Among 123 patients (mean age: 78 years), risk scores confirmed an intermediate risk (EuroSCORE II: 6.1%, JapanSCORE: 7%, JapanSCORE II: 21%), with rates of in-hospital mortality of 3.3%, stroke of 5.7%, and respiratory failure of 22%. Five- and 10-year survival rates were 66.3% and 42.6%, respectively, cardiac mortality rates were 4.8% and 7.2%, respectively, and event-free survival for MACCE were 66.6% and 55.1%, respectively. CONCLUSIONS: The outcomes of SAVR+CABG in the pre-TAVI era demonstrate the efficacy and durability of surgical approaches, with favorable long-term survival even in elderly intermediate risk patients. These findings highlight the continued significance of surgical intervention, particularly for patients requiring treatment for both AS and CAD, and provide a benchmark for assessing current treatment strategies in the TAVI era.