Transcatheter Aortic Valve Implantation (TAVI) and FFR-Guided PCI vs. Surgical AVR and CABG in Severe Aortic Stenosis with Complex CAD

The TCW Trial compared TAVI + FFR-guided PCI versus SAVR + CABG in patients with severe aortic stenosis and complex coronary artery disease. This multicenter, randomized controlled trial included 172 patients aged ≥70 years. At 1 year, the primary composite endpoint (death, MI, stroke, revascularization, valve reintervention, or major bleeding) was significantly lower in the TAVI + PCI group (4%) compared to SAVR + CABG (23%), meeting both noninferiority and superiority criteria. The study suggests TAVI + PCI as a safer, less invasive alternative with reduced mortality and bleeding risks in selected patients.