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Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
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Assessment, treatment, and prognostic implications of CAD in patients undergoing TAVI

Edward Danson1, Peter Hansen2, Sayan Sen3

  • 1St George's University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London SW17 0QT, UK.

Nature Reviews. Cardiology
|February 12, 2016
PubMed

Insights

Coronary artery disease (CAD) is common in patients undergoing transcatheter aortic valve implantation (TAVI). Current methods for assessing CAD and guiding revascularization are inadequate, necessitating new approaches for better patient outcomes.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Coronary artery disease (CAD) frequently coexists with severe aortic stenosis in patients undergoing transcatheter aortic valve implantation (TAVI).
  • The clinical significance and optimal management of CAD in this population remain controversial.
  • Current guidelines do not recommend routine coronary revascularization in TAVI patients.

Purpose of the Study:

  • To review current methods for assessing CAD in TAVI patients.
  • To evaluate the safety and efficacy of percutaneous coronary intervention (PCI) in this cohort.
  • To highlight the need for improved diagnostic strategies for CAD to guide revascularization decisions.

Main Methods:

  • Literature review of studies assessing CAD in TAVI populations.
  • Analysis of data on PCI safety and efficacy in TAVI patients.
  • Discussion of the impact of aortic stenosis on functional CAD assessment.

Main Results:

  • Existing methods for CAD assessment in TAVI patients are insufficient.
  • The role of PCI in TAVI patients requires further clarification.
  • Aortic stenosis may confound the functional assessment of CAD.

Conclusions:

  • There is a critical need for a validated method to assess CAD as a cause of myocardial ischemia in severe aortic stenosis patients undergoing TAVI.
  • Improved assessment strategies are essential to guide appropriate revascularization decisions.
  • Better management of CAD in TAVI patients may improve clinical outcomes.

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