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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
14:14

Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement

Published on: December 11, 2017

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To revascularize or not before transcatheter aortic valve implantation?

Sergio Perez1, Torin P Thielhelm2, Mauricio G Cohen1

  • 1Cardiovascular Division, University of Miami Miller School of Medicine, Miami, FL, USA.

Journal of Thoracic Disease
|December 4, 2018
PubMed

Insights

Management of coronary artery disease (CAD) in patients undergoing transcatheter aortic valve replacement (TAVR) is complex. While guidelines exist for surgical repair, TAVR introduces new considerations for revascularization strategies to optimize patient outcomes.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Concomitant coronary artery disease (CAD) and aortic stenosis affect 60-75% of patients undergoing aortic valve replacement.
  • Current guidelines recommend simultaneous surgical aortic valve replacement and bypass surgery for CAD, based on limited evidence.
  • Transcatheter aortic valve replacement (TAVR) has challenged traditional revascularization strategies, with observational studies showing no significant outcome differences in TAVR patients with or without CAD.

Purpose of the Study:

  • To review the management of coronary artery disease (CAD) in patients undergoing transcatheter aortic valve replacement (TAVR).
  • To discuss the indications, timing, and technical considerations for percutaneous coronary intervention (PCI) in TAVR candidates.
  • To explore adjunctive pharmacological therapies and future research directions.

Main Methods:

  • Review of current guidelines and observational studies.
  • Analysis of percutaneous coronary intervention (PCI) strategies before, during, and after TAVR.
  • Discussion of technical aspects, device selection, and pharmacological therapies.

Main Results:

  • Percutaneous coronary intervention (PCI) in aortic stenosis patients is safe, but optimal timing and indications remain debated.
  • Complete revascularization before TAVR may benefit selected patients with extensive CAD.
  • Combined PCI and TAVR or PCI after TAVR are options for specific clinical scenarios.

Conclusions:

  • The optimal management of CAD in TAVR candidates requires careful consideration of individual patient factors and lesion characteristics.
  • Randomized clinical trials are needed to further clarify the role and indications of revascularization in the TAVR population.
  • This review provides comprehensive insights into managing CAD in TAVR candidates, including technical and pharmacological aspects.

Keywords:
Transcatheter aortic valve replacement (TAVR)aortic stenosis (AS)coronary artery disease (CAD)percutaneous coronary intervention (PCI)revascularization

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