Abstract Body (Do not enter title and authors here): Background:
Aortic stenosis (AS) and coronary artery disease (CAD) frequently coexist, often requiring both valve replacement and coronary revascularization. While surgical aortic valve replacement with coronary artery bypass grafting (SAVR+CABG) remains the standard approach, transcatheter aortic valve replacement combined with percutaneous coronary intervention (TAVR+PCI) offers a less invasive option, particularly for high-risk patients. This systematic review and meta-analysis aims to compare the clinical outcomes of these two strategies, with a primary focus on all-cause mortality.

Methods:
We conducted a systematic review of randomized controlled trials, cohort studies, and case-control studies involving adults with AS and CAD who underwent either TAVR+PCI or SAVR+CABG. A comprehensive search of PubMed, EMBASE, Cochrane Library, Scopus, Web of Science, and CINAHL was performed in April 2025, following PRISMA guidelines. The protocol was registered in PROSPERO (CRD420251031831). Data were pooled using a random-effects model in R (version 3.4.3), and results were reported as relative risks (RRs) with 95% confidence intervals (CIs). Heterogeneity was assessed using the I2 statistic. Risk of bias was evaluated using the Cochrane RoB 2.0 tool for RCTs and ROBINS-I for non-randomized studies.

Results:
Seven studies from prior reviews were included. Of 2,695 articles screened in our updated search, 13 studies met inclusion criteria, comprising a total of 161,980 patients. Compared to SAVR+CABG, TAVR+PCI was associated with lower 30-day mortality (RR 0.70; 95% CI: 0.60–0.83; p < 0.01), reduced myocardial infarction (MI) at 30 days (RR 0.50; 95% CI: 0.37–0.68; p < 0.01), decreased risk of acute kidney injury (AKI) (RR 0.41; 95% CI: 0.23–0.74; p = 0.01), and fewer cerebrovascular accidents (CVA) at 30 days (RR 0.83; 95% CI: 0.70–0.98; p = 0.03). However, SAVR+CABG was associated with fewer pacemaker implantations (RR 2.19; 95% CI: 1.77–2.70; p < 0.01) and fewer vascular complications (RR 3.29; 95% CI: 1.59–6.81; p < 0.01). No significant differences were observed in two-year mortality, MI at two years, need for coronary intervention, rehospitalization, sepsis, or major bleeding.

Conclusion:
Our findings suggest that TAVR+PCI offers favorable safety outcomes but presents higher device-related complication risks. Further randomized trials are needed to make stronger recommendations.