To revascularize or not before transcatheter aortic valve implantation?

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.