Heart disease trial supports less-invasive alternative to SAVR, CABG surgery

Editor's Note

Contrary to previous findings, less-invasive percutaneous intervention combining fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) with transcatheter aortic valve replacement (TAVR) could be a viable alternative to surgery for patients with severe aortic stenosis (AS) and concomitant obstructive coronary artery disease (CAD). That’s according to the results of the TCW randomized trial, a European study highlighted in a May 14 report from MedPage Today.

“Previous observational research had shown that the percutaneous-only approach to AS and CAD left patients with higher rates of cardiac and vascular complications” compared with combined surgical aortic valve replacement (SAVR) and coronary artery bypass grafting (CABG), MedPage reported from the annual EuroPCR meeting in Montreal, Quebec, where results were presented. Although the TCW study was halted after enrolling only 172 participants due to excess deaths (largely cardiovascular), the benefits of the percutaneous approach became more apparent with time, with one expert highlighting “near lack of deaths at 30 days in the whole study -- counting only one in the surgical arm.” After 1 year, results showed fewer instances of all-cause mortality, myocardial infarction (MI), disabling stroke, unscheduled clinically-driven target vessel revascularization, valve re-intervention, and life-threatening or disabling bleeding.

The full report offers more detail on the data as well as commentary from various experts at the EuroPCR meeting.