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TransCatheter aortic valve implantation and fractional flow reserve-guided percutaneous coronary intervention versus

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Percutaneous treatment with FFR-guided PCI plus TAVI is non-inferior and superior to SAVR plus CABG for severe aortic stenosis and complex coronary artery disease, showing better outcomes.

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Severe aortic stenosis often co-exists with obstructive coronary artery disease.
  • Current guidelines favor combined surgical aortic valve replacement (SAVR) and coronary artery bypass grafting (CABG).
  • Transcatheter aortic valve implantation (TAVI) with fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) is an alternative.

Purpose of the Study:

  • To test the non-inferiority of FFR-guided PCI plus TAVI versus SAVR plus CABG.
  • To evaluate the efficacy and safety of these combined treatments in patients with severe aortic stenosis and complex coronary artery disease.

Main Methods:

  • An international, multicenter, prospective, randomized controlled trial involving 172 patients (≥70 years).
  • Patients were randomized 1:1 to FFR-guided PCI plus TAVI or SAVR plus CABG.
  • The primary endpoint was a composite of mortality, MI, stroke, revascularization, valve reintervention, and bleeding at 1 year.

Main Results:

  • FFR-guided PCI plus TAVI showed favorable primary endpoint outcomes (4% vs 23%), demonstrating non-inferiority (p<0.001).
  • This percutaneous approach was superior to SAVR plus CABG (HR 0.17, p<0.001).
  • Superiority was driven by lower all-cause mortality (0% vs 10%) and life-threatening bleeding (2% vs 12%).

Conclusions:

  • FFR-guided PCI plus TAVI is a safe and effective alternative to SAVR plus CABG.
  • This percutaneous strategy offers improved mortality and reduced bleeding complications.
  • This is the first trial to demonstrate favorable outcomes with percutaneous treatment in this patient population.