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Tagliari et al. Vessel Plus 2020;4:16 I http://dx.doi.org/10.20517/2574-1209.2020.05 Page 9 of 12

Figure 5. Pros and cons of TAVI combined with other transcatheter interventions. TAVI: transcatheter aortic valve implantation; PCI:
percutaneous coronary intervention; LAAO: left atrial appendage occlusion
hospital stay and a reduced need for post-acute rehabilitation services make TAVI a cost-effective approach,
particularly when transfemoral access is suitable. In the setting of concomitant functional MR and AS, a
cost-effective approach would be to perform TAVI first, followed by the mitral intervention in those who
do not experience improvement in MR, reducing, therefore, the number of mitral valve interventions in
[28]
comparison to routine simultaneous procedures . On the other hand, concomitant PCI and TAVI have
[69]
the potential to reduce operational and re-hospitalization costs, and has been considered . Regarding
the other possible combinations, many health insurance companies have the policy of not paying for a
combined intervention, which may have an impact on final reimbursement value and somehow discourage
[70]
concomitant approaches .

CONCLUSION
In this paper, we present an update on the most frequent indications for TAVI combined with other
transcatheter procedures, whose pros and cons are summarized in Figure 5.

In patients with concomitant heart disease, such as CAD, mitral or tricuspid valve disease, atrial fibrillation,
PFO or ASD, or aorta aneurysm, especially in those not candidates for complex conventional surgery, TAVI
combined with other transcatheter interventions offers a unique opportunity for a complete treatment,
either by staged or simultaneous interventions.

The decision about which approach (staged vs. single session) is more suitable for each patient needs to be
based on individual characteristics and clinical, anatomical, and procedure-related factors.

DECLARATIONS
Authors’ contributions
Made substantial contributions to the conception, design and review of this article: Tagliari AP, Taramasso
M