TransCatheter aortic valve implantation and fractional flow reserve-guided percutaneous coronary intervention versus conventional surgical aortic valve replacement and coronary bypass grafting for treatment of patients with aortic valve stenosis and complex or multivessel coronary disease (TCW): an international, multicentre, prospective, open-label, non-inferiority, randomised controlled trial.

Lancet (London, England)·December 21, 2025·PMID 39644913

Why it matters

This is the first randomized trial comparing a fully percutaneous strategy to conventional surgery in patients with combined severe aortic stenosis and complex coronary disease, a common and high-risk population. The results challenge current guideline recommendations favoring surgery.