ACC.26 – Late-breaker host Dr Harriette Van Spall (McMaster University, Hamilton, CA) is joined onsite by Michiel Voskuil (UMC Utrecht, Utrecht, NL) to discuss the PRO‑TAVI trial, a multicenter randomized study comparing TAVI with or without routine preprocedural PCI in patients with severe aortic stenosis and concomitant coronary artery disease.  

PRO‑TAVI tackles the ongoing controversy over whether routine PCI before TAVI improves outcomes, in a population where CAD is common but prior data have not demonstrated a clear mortality benefit from revascularization. The trial randomizes 466 patients to PCI before TAVI versus a strategy of deferring PCI, assessing a composite endpoint of all‑cause mortality, myocardial infarction, stroke, or major bleeding at 12 months, alongside key secondary outcomes such as repeat revascularization, quality of life, and cost‑effectiveness.  

Their conversation highlights the practical implications for the heart team: which coronary lesions truly warrant treatment before TAVI, how to integrate physiological assessment into procedural planning, and how to balance procedural complexity, bleeding risk, and future coronary access against potential benefits of preprocedural PCI. Viewers will gain bedside‑level guidance on when a conservative versus routine revascularization strategy is appropriate, and how PRO‑TAVI may influence future guideline recommendations and everyday decision‑making in TAVI candidates.  

Editor: Mirjam Boros  
Video Specialist: David Ben-Harosh, Tom Green

Support: This is an independent discussion produced by Radcliffe Cardiology.  

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