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Cangemi et al. Mini-invasive Surg 2022;6:3 https://dx.doi.org/10.20517/2574-1225.2021.99 Page 9 of 13

Table 3. Features of the main studies on hybrid approach, percutaneous coronary intervention, and surgical aortic valve replacement
treatment
Number PCI to surgery PCI vessels In-hospital
of and type of Valve Type of surgery Complications
patients (Time) intervention mortality
Santana et al. [74] 123 39 days (median) LAD (48%) SAVR (123) Right anterior Blood transfusion 30-day
LAD prox (27.6 thoracotomy 41, mortality 2
%) Reoperation for (1.6%)
LCX (32.5%) bleeding 1,
RCA (33.3%) Stroke 1,
RI (0.8%) Dialysis 2
Diagonal (5.7%)
PCI 121
POBA 2
Brinster et al. [75] 18 < 1 day LAD (61%) SAVR (18) Right anterior 8 blood 1
(12, same day but LCX (27%) thoracotomy transfusions,
two stages) RCA (17%) 1 stroke
PCI 18
POBA 0
George et al. [76] 26 Simultaneously Valve-PCI: Reoperative Primary valve Blood transfusion 0
(one stage) RCA (25.7%); valve-PCI surgery: 1,
LCX (29.1%); patient (14); Hemisternotomy Reoperation for
LM (15.6%) Primary valve (2) bleeding 1,
LAD prox surgery (12) of Sternotomy (10) Stroke 1
(10.6%) these
LAD mid distal SAVR (11) Reoperative valve
(32.2%) surgery:
Sternotomy (13)
Right thoracotomy
(1)

LAD: Left anterior descending; LCX: left circumflex; LM: left main; PCI: percutaneous intervention; POBA: plain old balloon angioplasty; RCA: right
coronary artery; RI: ramus intermedius; SAVR: surgical aortic valve replacement ; SVG: saphenous vein grafts.

research. The timing of PCI in TAVI candidates should be established considering the complexity of the
coronary anatomy, type of valve prosthesis, symptoms, and comorbidities of the patient. Furthermore, the
progressive younger age of patient candidates for TAVI makes the possibility of re-accessing the coronary
arteries increasingly important. Thus, further studies on increasing coronary re-access after TAVR and best
timing of PCI in relation to TAVI are necessary. Hybrid procedures may be the best answer in some
selected patients. The best management of this condition is paradigmatic of the modern cardiology
approach that is founded on Heart Team decisions. Modern cardiology is evolving towards tailored
therapies which need collaboration among medical specialties that were once divided.

DECLARATIONS
Authors’contributions
Conception and design: Cangemi S
Drafting the article: Cangemi S
Final approval of the version to be published: Bianchini F, Trani C
Analysis and interpretation: Romagnoli E, Bruno P
Data collection: Burzotta F, Nesta M
Critical revision of the article: Aurigemma C

Availability of data and materials
Not applicable.