Survival and post-operative outcomes
Coronary revascularization is employed in stable disease to reduce
cardiovascular events, prevent emergency revascularization, and improve
symptoms in disease refractory to medical
management[10,13]. CABG is preferred over PCI for
revascularization of extensive, high-complexity, or significant left
main CAD[13]. In this population CABG has been
proven to decrease all-cause mortality, reduce risk of late spontaneous
MI, and lower likelihood of requiring repeat revascularization. Surgical
intervention is likewise necessary for aortic stenosis. While survival
is excellent during the asymptomatic phase, mortality spikes to
>90% within two years of symptom
onset[8]. In the United States, TAVR is approved
for use in patients regardless of risk strata and has shown
non-inferiority at all risk levels. In high-risk population, TAVR
significantly lowers all-cause mortality and stroke rates when compared
to SAVR[17]. When extensive CAD and severe AS
exist concomitantly, treating one but not the other is associated with
worse outcomes regardless of sequence of procedures, thus hybrid
techniques are recommended[12,13].