What is the latest in the management of coronary artery disease in TAVI candidates?
PCR PerspectivesShow Notes
Ole De Backer and Daniel Blackman discuss the management of coronary artery disease in TAVI candidates at #europcr 2026, focusing on whether PCI should be performed before valve implantation or can be safely deferred.
They review PROTAVI, which supports a more selective strategy with PCI only when clinically indicated, suggesting less bleeding without clear harm from deferral. They contrast this with NOTION-3, which suggests a potential benefit of more systematic revascularisation before TAVI, but with important differences in design and endpoint definitions, particularly the inclusion of revascularisation in the primary outcome.
Overall, the discussion highlights that there is no universal strategy and that decisions should be individualised based on coronary complexity, ischaemic risk, and bleeding risk.
They also address a key clinical question often overlooked: how to manage patients with angina symptoms and whether valve treatment should still come first, followed by reassessment of coronary disease after TAVI.
A practical discussion on a complex and evolving area of TAVI care! Hosted on Acast. See acast.com/privacy for more information.
More from PCR Perspectives
In this #europcr 2026 conversation, Andreas Baumbach speaks with Raj Makkar about one of the most rapidly evolving areas in structural heart interventions: TAVI for aortic regurgitation. While TAVI has become an established treatment for aortic stenosis, managing patients with pure native aortic regurgitation remains more challenging. In recent years, dedicated transcatheter devices have been developed and evaluated, with encouraging results in patients who are at high surgical risk or unsuitable for surgery. The discussion focuses on the ALIGN-AR study, which assessed a dedicated TAVI device in patients with symptomatic, moderate-to-severe or severe aortic regurgitation who were not appropriate candidates for surgery. Andreas Baumbach and Raj Makkar review the study design, patient population, and key outcomes, and discuss how these findings may influence clinical practice. They also explore the current guideline recommendations and the future role of transcatheter therapies in the management of aortic regurgitation. Listen to this insightful discussion to learn about the latest evidence and emerging treatment options for this challenging patient population. Hosted on Acast. See acast.com/privacy for more information.
In this #europcr 2026 interview, Davide Capodanno and Peter Libby discuss the role of inflammation in atherosclerosis and why many high-risk coronary plaques remain undetected by angiography. Advances in vascular biology have revealed how inflammation contributes to plaque instability and rupture, yet vulnerable plaques may appear angiographically insignificant. How can these lesions be identified before they lead to clinical events? What role do inflammation and emerging therapeutic targets play in reducing residual cardiovascular risk? Listen to this discussion to explore the mechanisms of plaque vulnerability and their implications for coronary artery disease management. Hosted on Acast. See acast.com/privacy for more information.
Julien Dreyfus and Fabien Praz review the current indications and management of severe tricuspid regurgitation, highlighting that treatment is now recommended for symptomatic patients, and emphasising the importance of early referral before irreversible organ damage occurs. They outline a stepwise, multimodality diagnostic approach performed in expert heart valve centres, combining echocardiography, CT, right heart catheterisation and heart team evaluation to guide decision-making. Recent evidence shows that effective reduction of tricuspid regurgitation, whether through repair or replacement, can improve symptoms and reduce heart failure hospitalisations. The key message is that timely diagnosis, appropriate patient selection, and a tailored strategy are essential to optimise outcomes. Hosted on Acast. See acast.com/privacy for more information.
In this discussion, Lorenz Räber and David Seiffge review the latest evidence on percutaneous left atrial appendage (LAA) closure for stroke prevention, focusing on the CLOSURE AF and CHAMPION AF trials, highlighting that LAA closure provides stroke rates comparable to anticoagulation, with a key advantage in reducing bleeding risk. While a small signal of increased ischaemic stroke warrants further evaluation, the procedure is considered safe and particularly valuable for patients at high bleeding risk or unable to tolerate anticoagulation. Careful patient selection remains essential, with emerging interest in its use for patients experiencing stroke despite anticoagulation. Hosted on Acast. See acast.com/privacy for more information.
In this episode, Xavier Freixa and Nina Wunderlich discuss how to better anticipate challenges in LAA closure. Moving beyond traditional morphology classifications, they highlight the importance of clinically relevant anatomical parameters, procedural factors such as coaxiality, and proper planning to optimise outcomes. They also explore what defines an ideal implant and the key role of operator experience and preparedness in managing complex cases. Hosted on Acast. See acast.com/privacy for more information.