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Published on: March 26, 2018

Changing strategy for aortic stenosis with coronary artery disease by transcatheter aortic valve implantation

Junjiro Kobayashi1

  • 1Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan, jkobayas@hsp.ncvc.go.jp.

General Thoracic and Cardiovascular Surgery
|April 3, 2013
PubMed

Insights

Transcatheter aortic valve implantation (TAVI) is a viable option for patients with severe aortic stenosis (AS) and coronary artery disease (CAD), especially after prior coronary artery bypass grafting (CABG). TAVI offers a potentially safer alternative to traditional surgery in these complex cases.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Coronary artery disease (CAD) frequently coexists with aortic stenosis (AS), affecting 40-50% of patients with typical angina.
  • Transcatheter aortic valve implantation (TAVI) guidelines have evolved for AS in high-comorbidity patients.
  • Coronary artery bypass grafting (CABG) is recommended for significant coronary stenosis, with over 60% performed off-pump in Japan.

Purpose of the Study:

  • To delineate the rationale for TAVI in patients with severe AS and concomitant CAD.
  • To evaluate the safety and efficacy of TAVI in patients with varying degrees of CAD.
  • To explore the role of TAVI in patients with prior CABG and patent internal thoracic arteries.

Main Methods:

  • Review of current guidelines and clinical evidence regarding TAVI and surgical interventions for AS and CAD.
  • Analysis of operative risks and long-term outcomes associated with prophylactic aortic valve replacement (AVR) during CABG.
  • Assessment of TAVI as an alternative for patients with severe AS and prior CABG, particularly with patent internal thoracic arteries.

Main Results:

  • Prophylactic AVR for moderate AS during CABG may increase early operative risks and long-term complications.
  • AVR after previous CABG carries significant risks, including potential injury to the left internal thoracic artery (LITA) and challenges in myocardial protection.
  • Severe AS with prior CABG and a patent LITA is a strong indication for TAVI.

Conclusions:

  • TAVI is a definite indication for patients with severe AS and prior CABG with a patent LITA.
  • The safety of TAVI across diverse CAD extents and anatomies requires further investigation.
  • Hybrid TAVI approaches may offer reduced mortality and morbidity for high-risk patients in the future.

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