Deferring Coronary Intervention Before Aortic Valve Replacement Proves Safe for High Risk Elderly Patients

New cardiac trial finds that waiting to treat blocked arteries until after a valve replacement is safe and reduces bleeding risks for high-risk older patients.

By: AXL Media

Published: Mar 30, 2026, 8:38 AM EDT

Source: Information for this report was sourced from American College of Cardiology

The Clinical Debate Over Procedure Timing in Valve Patients

For elderly patients diagnosed with both a malfunctioning aortic valve and significant coronary artery disease, the medical community has long debated the optimal order of surgical intervention. Traditional practices in the United States often favor performing percutaneous coronary intervention, or stenting, prior to a transcatheter aortic valve replacement. However, new data from the Netherlands suggests that for high risk and older populations, a more conservative approach is equally effective. By prioritizing the valve replacement and only addressing arterial blockages if symptoms persist, surgeons can avoid unnecessary invasive procedures in fragile patients.

Evidence of Non Inferiority in High Risk Dutch Populations

The PRO-TAVI study tracked 466 patients with a median age over 80 years across twelve clinical sites between 2021 and 2024. Participants, all of whom had significant arterial blockages, were divided into two groups: one receiving a stent before their valve replacement and the other deferring the stent unless symptoms worsened. After twelve months, the composite rate of death, heart attack, and stroke was nearly identical between the groups, with 25.8% in the pre-procedure group and 24.1% in the deferred group. This statistical equivalence supports the practice of waiting to see if a patient’s chest pain resolves after the primary valve issue is fixed.

Significant Reductions in Major Bleeding Risks

A primary benefit of deferring arterial stenting is a marked decrease in the risk of serious bleeding events. The trial revealed that 14.8% of patients who received a stent before their valve replacement suffered major bleeding, compared to only 6.2% of those who waited. Lead author Michiel Voskuil attributed this difference to the dual antiplatelet therapy required after stenting, which increases the likelihood of hemorrhaging during the subsequent valve surgery. While these bleeding incidents did not lead to higher mortality rates, they represent a significant post-operative complication that can be avoided through better procedural timing.