Coronary revascularization and TAVI: before, during, after or never?

Area of Science:

• Cardiology
• Interventional Cardiology
• Geriatric Medicine

Background:

• Severe aortic stenosis (AS) and coronary artery disease (CAD) often coexist in elderly patients.
• Transcatheter aortic valve implantation (TAVI) is a common treatment for severe AS.
• Managing concomitant obstructive CAD in TAVI candidates is crucial.

Purpose of the Study:

• To review the safety and feasibility of percutaneous coronary intervention (PCI) in elderly patients with severe AS.
• To discuss the optimal timing of PCI relative to TAVI.

Main Methods:

• Review of current evidence on PCI in severe AS patients undergoing TAVI.
• Analysis of factors influencing the decision for staged versus concomitant PCI.
• Evaluation of safety and feasibility data for different PCI timing strategies.

Main Results:

• PCI is feasible and safe in selected high-risk or inoperable patients with severe AS.
• Staged PCI (before TAVI) is common, especially for complex CAD or renal impairment.
• Concomitant PCI (during TAVI) is safe for less complex CAD and without severe renal impairment.

Conclusions:

• PCI is a viable option for managing CAD in TAVI candidates.
• The optimal timing of PCI depends on CAD complexity and patient comorbidities.
• Individualized treatment strategies are essential for optimal patient outcomes.