EuroPCR 2026: Selected late-breaking trials from Day 3

New late-breaking data from EuroPCR 2026 suggest that physiology-guided coronary intervention, dedicated transcatheter valves for pure aortic regurgitation and tailored procedural strategies in bicuspid anatomy may improve outcomes and expand treatment options in contemporary TAVI practice.

As Day 3 of EuroPCR 2026 continued, late-breaking presentations highlighted evolving strategies in transcatheter valve intervention and coronary management for complex, high-risk patients. Key studies explored physiology-guided coronary revascularization during TAVI, the use of dedicated transcatheter heart valves (THVs) for pure aortic regurgitation (AR), and procedural optimization with balloon pre-dilatation in bicuspid transcatheter aortic valve replacement (TAVR)

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FFR-guided revascularization reduces adverse events in high bleeding risk patients undergoing TAVI

What do the data show?

A subanalysis of a multicenter randomized trial evaluated coronary revascularization strategies in patients with severe aortic stenosis and high bleeding risk undergoing TAVI. Investigators compared fractional flow reserve (FFR)-guided revascularization with routine angiography-guided percutaneous coronary intervention (PCI) in patients with angiographically intermediate coronary artery disease.

Among the overall study population, 180 patients (63%) met VARC-HBR criteria for high bleeding risk. PCI was performed significantly less frequently in the FFR-guided group compared with the angiography-guided PCI group (48% versus 93%; p<0.001). At 12 months, the primary composite endpoint of death, myocardial infarction, stroke, revascularization or major bleeding occurred less frequently in patients managed with an FFR-guided strategy (6% versus 18%; hazard ratio 0.30; 95% confidence interval 0.11–0.81; p=0.02). The composite of all-cause mortality or myocardial infarction was also significantly reduced with FFR guidance (1% versus 9%; hazard ratio 0.11; 95% confidence interval 0.01–0.85; p=0.03).

Periprocedural death, stroke or major bleeding occurred in no patients assigned to FFR-guided revascularization compared with 8% of those undergoing angiography-guided PCI (p=0.01). Importantly, deferral of PCI based on negative FFR findings was not associated with an excess risk of adverse events.

Key clinical takeaway

In high bleeding risk patients undergoing TAVI, an FFR-guided coronary revascularization strategy may safely reduce the need for PCI while lowering major adverse cardiovascular and bleeding events. These findings support a more selective, physiology-guided approach to coronary intervention in this vulnerable patient population.

Reference: Scarsini R, et al. Coronary revascularization strategies in high bleeding risk patients undergoing TAVI. Presented at: EuroPCR 2026, Paris, France, May 21, 2026.

Dedicated THV demonstrates comparable survival to surgery in pure aortic regurgitation 

What do the data show?

The EROICA study is the first multinational European analysis to directly compare transcatheter heart valve (THV) implantation using a dedicated device with surgical aortic valve replacement (SAVR) for the treatment of isolated pure aortic regurgitation (AR). Investigators retrospectively analysed 915 patients treated across 12 high-volume centres between 2021 and 2025, including 357 patients treated with the JenaValve Trilogy THV system and 558 treated with SAVR. Patients undergoing THV were older and had substantially higher surgical risk and comorbidity burden than those undergoing surgery. Despite these baseline differences, 30-day and 1-year survival rates were similar between THV and SAVR in both unmatched and age- and sex-matched analyses. THV was associated with higher rates of vascular complications and permanent pacemaker implantation, while acute kidney injury occurred more frequently after SAVR. THV also demonstrated lower discharge gradients, although mild or no paravalvular leak was more common following surgery. The findings suggest dedicated THV systems may provide a viable alternative to surgery in selected patients with pure AR.

Key clinical takeaway

Dedicated THV systems for pure AR may offer comparable short- and mid-term survival to SAVR, even in older and higher-risk patients. While pacemaker implantation and vascular complications remain important considerations with THV, these data support its growing role as a less invasive treatment option for patients unsuitable for surgery.

Reference: Geyer M, et al. Treatment of pure aortic regurgitation with a dedicated THV vs. surgery – first results of EROICA. Presented at: EuroPCR 2026, Paris, France, May 21, 2026.

Balloon pre-dilatation improves device success in bicuspid TAVR with BEV 

What do the data show?

A multicentre retrospective analysis evaluated the impact of balloon pre-dilatation versus direct valve implantation in patients with Sievers type 1 bicuspid aortic valve stenosis undergoing transcatheter aortic valve replacement (TAVR) with balloon-expandable valves. The study included 383 patients treated across 24 tertiary centres between 2016 and 2023 using the Edwards Sapien 3 or Sapien 3 Ultra valve systems. Balloon pre-dilatation was performed in 48% of patients and was more commonly used in individuals with greater leaflet and raphe calcification. Following propensity score matching, 115 patient pairs were analysed. Balloon pre-dilatation was associated with significantly higher device success rates compared with direct implantation, primarily driven by lower residual transvalvular gradients. Patients undergoing pre-dilatation also demonstrated improved haemodynamic performance, including larger effective orifice areas and lower rates of moderate-to-severe prosthesis–patient mismatch. Importantly, early safety outcomes were comparable between groups, with no increase in cerebrovascular events or pacemaker implantation at 30 days. The findings suggest pre-dilatation may optimise procedural outcomes in bicuspid anatomy without compromising safety.

Key clinical takeaway

In patients with Sievers type 1 bicuspid aortic stenosis undergoing TAVR with balloon-expandable valves, balloon pre-dilatation may improve device success and valve haemodynamics while maintaining a similar safety profile to direct implantation. These findings support a more tailored procedural strategy in complex bicuspid anatomy, particularly in heavily calcified valves.

Reference: Arturi F, et al. Pre-dilatation vs. direct valve implant for TAVI with balloon-expandable valve in Sievert Type 1 bicuspid aortic valve. Presented at: EuroPCR 2026, Paris, France, May 21, 2026.