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Thorac Cardiovasc Surg
DOI: 10.1055/a-2798-0041
Letter to the Editor

Beyond Renal Stability: Rethinking Decisions After Combined Valve–Coronary Care

Authors

  • Khaled Alebrahim 

    1   Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
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Letter to:

Renal Function After Combined Treatment for Coronary Disease and Aortic Valve ReplacementThorac Cardiovasc Surg 2025; 73(08): 639-648
DOI: 10.1055/a-2493-1495

10.1055/a-2493-1495

I read with interest the article by Taghiyev et al. examining short-term renal outcomes after combined treatment for aortic stenosis and coronary artery disease (CAD).[1] While the authors provide useful early data on creatinine trajectories, the study's narrow renal focus, limited sample size, and 7-day follow-up restrict its clinical impact. Major decisions between transcatheter aortic valve replacement (TAVR) + percutaneous coronary intervention (PCI) and surgical aortic valve replacement (SAVR) + coronary artery bypass grafting (CABG) hinge on a broader matrix of determinants—including frailty, anatomical complexity, operative risk, durability expectations, and all-cause morbidity and mortality—not on transient renal fluctuations alone. Recent literature comparing TAVR + PCI versus SAVR + CABG in patients with atherosclerosis and CAD offers a more nuanced picture. A large multicenter registry published in 2025 reported that, in intermediate-risk patients, early (30-day) mortality was similar between the two strategies; over 3 years the unmatched analysis even showed higher mortality in the TAVR + PCI group (37.1 vs. 25.5%, p = 0.02), although after propensity matching the difference lost significance.[2] Notably, early surgical complications—including stroke, acute kidney injury, bleeding, transfusion requirement, and delirium—were more common in the SAVR + CABG group, whereas TAVR + PCI had higher rates of pacemaker implantation and vascular complications.[2]

Moreover, a recent meta-analysis including over 100,000 patients found that TAVR + PCI was associated with lower rates of 30-day acute kidney injury, but higher long-term all-cause mortality and increased need for repeat coronary revascularization compared with SAVR + CABG.[3]

Thus, while TAVR + PCI may offer some short-term advantages (reduced acute kidney injury, shorter hospitalization, fewer early bleeding, or surgical complications), these benefits must be weighed against potentially worse long-term survival, higher rate of repeat coronary interventions, and nontrivial vascular/conduction complications.[4] [5] [6]

Given these data and the many variables at play—comorbidities, coronary disease complexity, anatomical considerations, procedural risk, and long-term durability—I remain unconvinced that early renal stability alone is a sufficiently robust basis to favor one strategy over another. Until larger prospective studies with long-term follow-up address survival, major adverse cardiac and cerebrovascular event, reinterventions, and quality-of-life outcomes, claims of superiority of one strategy on the basis of short-term renal data remain premature.

Contributors' Statement

K.A. contributed to conceptualization, data curation, methodology, visualization, writing—original draft, writing—review and editing.




Publication History

Received: 30 December 2025

Accepted: 26 January 2026

Article published online:
11 February 2026

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