Background: Coronary artery disease (CAD) is associated with poorer outcomes after aortic valve replacement\n(AVR). For high-risk patients with complex CAD, combined transcatheter aortic valve replacement (TAVR) plus offpump/\nminimally-invasive coronary artery bypass (OPCAB/MIDCAB) has been proposed.\nMethods: A prospective registry analysis was performed to compare the characteristics and outcomes of patients\nundergoing TAVR+OP/MIDCAB with those undergoing TAVR plus percutaneous coronary intervention (PCI) and\nsurgical AVR plus coronary artery bypass grafting (CABG) between 2008 and 2015 at a single site in Germany.\nResults: 464 patients underwent SAVR+CABG, 50 underwent TAVR+OP/MIDCAB, and 112 underwent TAVR+PCI.\nThe mean ages (p < 0.001) and logistic EuroSCOREs (p < 0.001) were similarly higher in TAVR+OP/MIDCAB and\nTAVR+PCI patients compared to SAVR+CABG patients. Prior cardiac surgery was more common in TAVR+PCI\nthan in TAVR+OP/MIDCAB and SAVR+CABG patients (p < 0.001). Procedural times were shortest (p < 0.001),\ncreatine kinase (muscle brain) levels least elevated (p < 0.001), pericardial tamponade least common (p = 0.027),\nand length of hospital stay shortest (p = 0.011) in TAVR+PCI, followed by TAVR+OP/MIDCAB and SAVR+CABG\npatients. In-hospital mortality was highest for TAVR+OP/MIDCAB patients (18.0%) with comparable rates for\nTAVR+PCI and SAVR+CABG groups (9.0 and 6.9%; p = 0.009). Mortality by 12 months was more probable after\nTAVR+OP/MIDCAB (HR: 2.17, p = 0.002) and TAVR/PCI (HR: 1.63, p=0.010) than after SAVR+CABG, with the\nsame true of rehospitalisation (HR: 2.39, p = 0.003 and HR: 1.63, p = 0.033).\nConclusions: TAVR+OP/MIDCAB patients share many characteristics with TAVR+PCI patients, with only slightly\npoorer long-term outcomes. In patients ineligible for SAVR+CABG and TAVR+PCI, hybrid interventions are\nreasonable second-line options.
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