SURTAVI Compares Completely Percutaneous Approach to TAVR and PCI Versus SAVR and CABG for Intermediate-Risk Patients

September 10, 2019—Results from the randomized SURTAVI trial were published by Lars Søndergaard, MD, et al in Circulation. The study compared a completely percutaneous approach to transcatheter aortic valve replacement (TAVR) and percutaneous coronary intervention (PCI) versus surgical aortic valve replacement (SAVR) and coronary artery bypass grafting (CABG) in patients with severe aortic stenosis (AS) and coronary artery disease (CAD) who are at intermediate surgical risk.

The SURTAVI investigators concluded that the completely percutaneous approach is a reasonable alternative to SAVR and CABG for patients at intermediate surgical risk with severe AS and noncomplex CAD (SYNTAX score ≤ 22).

The prospective SURTAVI trial enrolled intermediate-risk patients with severe AS from 87 centers in the United States, Canada, and Europe between June 2012 and June 2016. Complex CAD with a SYNTAX score > 22 was an exclusion criterion.

In the study, investigators stratified patients according to need for revascularization and then randomized to treatment with TAVR or SAVR. Patients assigned to revascularization in the TAVR group underwent PCI, whereas those in the SAVR group underwent CABG. The primary endpoint was the rate of all-cause mortality or disabling stroke at 2 years.

As summarized in Circulation, of the 1,660 patients who underwent attempted aortic valve implantation, 332 (20%) were assigned to revascularization. These patients had a higher Society of Thoracic Surgeons risk score for mortality (4.8% ± 1.7% vs 4.4% ± 1.5%; P < .01) and were more likely to be male (65.1% vs 54.2%; P < .01) than the 1,328 patients not assigned to revascularization.

After randomization to treatment, there were 169 TAVR and PCI patients, 163 SAVR and CABG patients, 695 TAVR patients, and 633 SAVR patients. No significant difference in the rate of the primary endpoint was found between TAVR and PCI and SAVR and CABG (16% [95% confidence interval {CI}, 11.1–22.9] vs 14% [95% CI, 9.2–21.1]; P = .62) or between TAVR and SAVR (11.9% [95% CI, 9.5–14.7] vs 12.3% [95% CI, 9.8–15.4]; P = .76), reported the SURTAVI investigators in Circulation.