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Timing and Outcomes of PCI in the TAVR Era

Konstantinos V Voudris1,2, Peter Petropulos3, Panagiotis Karyofillis4

  • 1Department of Medicine, University of Illinois at Chicago/Advocate Christ Medical Center, Chicago, IL, USA. Kvoudris@gmail.com.

Current Treatment Options in Cardiovascular Medicine
|March 7, 2018
PubMed

Insights

Transcatheter aortic valve replacement (TAVR) is common for severe aortic stenosis. Managing coronary artery disease (CAD) alongside TAVR, including percutaneous coronary intervention (PCI), requires careful consideration of timing for optimal patient outcomes.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Transcatheter aortic valve replacement (TAVR) is a standard treatment for symptomatic severe aortic stenosis (AS).
  • Obstructive coronary artery disease (CAD) is frequently observed in patients undergoing TAVR.
  • Optimal management strategies for concurrent CAD in TAVR patients are not well-defined.

Purpose of the Study:

  • To review current management strategies for patients with severe aortic stenosis and concomitant obstructive coronary artery disease undergoing TAVR.
  • To discuss the optimal timing of percutaneous coronary intervention (PCI) in relation to TAVR.

Main Methods:

  • Review of current literature and expert opinion on the management of CAD in TAVR patients.
  • Analysis of the feasibility and safety of PCI in this patient population.
  • Discussion of different revascularization timing strategies (before, during, or after TAVR).

Main Results:

  • Percutaneous coronary intervention (PCI) is feasible and safe in patients with CAD and severe AS.
  • The optimal timing for revascularization (before, during, or after TAVR) is still debated.
  • Expert consensus suggests PCI before or at the time of TAVR if benefits outweigh risks.

Conclusions:

  • Individualized assessment is crucial for determining the best revascularization strategy.
  • Further large clinical trials are needed to establish definitive guidelines for revascularization timing.
  • Current recommendations favor PCI preceding or concurrent with TAVR when appropriate.
Abstract

Keywords:
CADCoronary artery diseasePCITAVR

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