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Coronary artery disease in patients undergoing TAVI: why, what, when and how to treat

Giulio G Stefanini1, Stefan Stortecky, Peter Wenaweser

  • 1Department of Cardiology, Bern University Hospital, Bern, Switzerland.

Eurointervention : Journal of Europcr in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
|September 27, 2014
PubMed

Insights

Coronary artery disease (CAD) frequently coexists with aortic valve stenosis (AS). This review examines the need for coronary revascularization in patients with both conditions undergoing transcatheter aortic valve implantation (TAVI).

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Coronary artery disease (CAD) and aortic valve stenosis (AS) often coexist, particularly in elderly patients.
  • CAD prevalence is high in patients undergoing aortic valve replacement (40%) and transcatheter aortic valve implantation (TAVI) (up to 60%).
  • Combined CAD and AS increases patient risk and treatment complexity compared to isolated AS.

Purpose of the Study:

  • To review evidence for coronary revascularization in patients with severe AS and CAD undergoing TAVI.
  • To summarize optimal timing and treatment strategies for percutaneous coronary interventions (PCI) in this patient group.

Main Methods:

  • Review of current European Society of Cardiology (ESC) and American College of Cardiology Foundation/American Heart Association (ACCF/AHA) guidelines.
  • Analysis of existing evidence on the prognostic implications of CAD in patients undergoing TAVI.
  • Summary of recommendations for PCI in patients with severe AS and significant coronary stenosis.

Main Results:

  • Coronary artery bypass grafting (CABG) combined with surgical aortic valve replacement improves survival in patients with CAD and AS.
  • Guidelines recommend CABG for patients with CAD undergoing surgical aortic valve replacement.
  • The prognostic impact of CAD in elderly patients undergoing TAVI remains debated, though PCI is considered for significant proximal stenosis.

Conclusions:

  • Evidence supports the need for coronary revascularization in select patients with severe AS and CAD undergoing TAVI.
  • Optimal timing and modality of PCI require careful consideration based on individual patient factors and coronary anatomy.
  • Further research is needed to clarify the role of PCI in improving outcomes for patients with concomitant CAD and severe AS undergoing TAVI.

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