THE Transcatheter Valve and Vessels (TCW) Trial, the first dedicated randomised, international study in patients with both aortic stenosis and advanced coronary disease, has delivered new insights into treatment strategies for this complex patient population. These findings were presented by Elvin Kedhi, McGill University Heath Center, Royal Victoria Hospital, Montreal, Canada, in the latest EuroPCR press conference of 2024.
The trial, comparing percutaneous (transcatheter aortic valve implantation and percutaneous coronary intervention) versus surgical (coronary artery bypass grafting and surgical aortic valve replacement) interventions, aimed to demonstrate non-inferior outcomes for the minimally invasive percutaneous approach compared to the guideline-recommended surgical technique. However, the trial was halted prematurely due to compelling evidence favouring the percutaneous approach.
Data from the trial revealed striking differences in mortality and primary endpoint outcomes between the two arms. Patients undergoing percutaneous interventions experienced zero mortality compared to a substantial 10% mortality rate in the surgical group. Similarly, the incidence of the primary endpoint was markedly lower in the percutaneous arm, with a rate of 4.5% compared to a staggering 23% in the surgical arm.
These findings challenge current treatment guidelines, suggesting that, contrary to previous beliefs, a percutaneous approach may offer superior outcomes for patients with aortic stenosis and advanced coronary disease. However, the researchers caution that longer-term follow-up data and larger randomised trials are essential to validate and further substantiate these findings.
The TCW trial underscores the critical need for ongoing research and re-evaluation of treatment paradigms, potentially reshaping clinical practice and improving outcomes for patients with these challenging comorbidities.
Reference:
Elvin Kedhi. Percutaneous versus surgical treatment for patients with aortic stenosis and coronary disease: The TCW TRIAL. EuroPCR 14.05.2024.
