Related Experiment Video
Updated: May 26, 2026
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Combined elective percutaneous coronary intervention and transapical transcatheter aortic valve implantation
Miralem Pasic1, Stephan Dreysse, Axel Unbehaun
1German Heart Center, Berlin, Germany. pasic@dhzb.de
Insights
Treating coronary artery disease (CAD) and severe aortic valve stenosis simultaneously with percutaneous coronary intervention (PCI) and transcatheter aortic valve implantation (TAVI) is feasible and safe for high-risk patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Coronary artery disease (CAD) and severe aortic valve stenosis often coexist in patients requiring transcatheter aortic valve implantation (TAVI).
- There is no established strategy for managing CAD in patients undergoing TAVI.
- Simultaneous treatment of both conditions presents a potential solution.
Purpose of the Study:
- To evaluate the feasibility and safety of a single-stage approach combining elective percutaneous coronary interventions (PCI) with transapical TAVI.
- To report initial outcomes of this combined strategy in high-risk patients.
Main Methods:
- A cohort of 46 high-risk patients with severe aortic valve stenosis and significant CAD underwent simultaneous transapical TAVI and elective PCI.
- Only the most significant coronary lesions were treated.
- Data on technical success, stent implantation, and short- and long-term survival were collected.
Main Results:
- The combined PCI and TAVI procedure demonstrated 100% technical success.
- The mean number of stents implanted per patient was 1.6.
- 30-day mortality was 4.3%, with 12-, 24-, and 36-month survival rates of 87.1%, 69.7%, and 69.7%, respectively.
Conclusions:
- A single-stage approach combining elective PCI and TAVI is feasible and safe for high-risk patients.
- This combined strategy has become the preferred treatment option for patients with severe aortic valve stenosis and concomitant CAD.
Abstract:
There is no established strategy of how and when to treat coronary artery disease (CAD) in patients referred for transcatheter aortic valve implantation (TAVI). Simultaneous, single-stage treatment of both pathologies is a possible solution. We report our initial results of simultaneously performed transapical TAVI and elective percutaneous coronary interventions (PCI) in high-risk patients with severe aortic valve stenosis. Between April 2008 and July 2011, a total of 419 patients underwent transapical TAVI. Combined elective PCI and TAVI were performed in 46 (11%) patients. Only the most significant coronary lesion or lesions were treated. Technical success of the combined approach was 100%. The mean count of implanted stents per patient was 1.6 ± 1.0 (range, 1-5 stents). The 30-day mortality rates in the PCI and TAVI group was 4.3%. Survival at 12, 24 and 36 months of the PCI and TAVI group 87.1 ± 5.5, 69.7 ± 10.3 and 69.7 ± 10.3%, respectively. The results showed that the single-stage approach with combined elective PCI and TAVI is feasible and safe. It has become our primary choice for treatment of high-risk patients with severe aortic valve stenosis and CAD.
