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Aortic Valve Disease and Associated Complex CAD: The Interventional Approach

Federico Marin1, Roberto Scarsini2, Rafail A Kotronias1

  • 1Oxford Heart Centre, Oxford University Hospitals, NHS Trust, Oxford OX3 9DU, UK.

Journal of Clinical Medicine
|April 3, 2021
PubMed

Insights

Managing coronary artery disease (CAD) in patients undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) requires careful consideration. This review synthesizes literature to aid Heart Teams in decisions regarding myocardial revascularization.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiovascular Surgery

Background:

  • Coronary artery disease (CAD) frequently coexists with severe aortic stenosis (AS).
  • Optimal management of CAD in patients undergoing transcatheter aortic valve implantation (TAVI) remains unclear.
  • Accurate assessment of coronary stenosis severity independent of AS is challenging.

Purpose of the Study:

  • To comprehensively review the literature on myocardial revascularization in patients with severe AS undergoing TAVI.
  • To provide guidance for Heart Teams in decision-making regarding revascularization strategies.
  • To highlight diagnostic challenges and prognostic uncertainties of CAD in this population.

Main Methods:

  • Systematic literature review of studies on CAD management in severe AS patients undergoing TAVI.
  • Synthesis of data on percutaneous coronary intervention (PCI) and surgical revascularization.
  • Analysis of diagnostic challenges, technical difficulties, and clinical outcomes.

Main Results:

  • Limited data exist on the optimal PCI strategy for CAD in TAVI patients.
  • The prognostic impact of CAD in this cohort is still debated.
  • PCI in severe AS presents technical challenges, including hemodynamic instability and bleeding risk.

Conclusions:

  • Individualized decisions for myocardial revascularization are crucial for severe AS patients undergoing TAVI.
  • Further research is needed to establish best practices for PCI in this complex patient group.
  • Balancing diagnostic accuracy, procedural risks, and potential benefits is key for optimal patient outcomes.

Keywords:
aortic stenosiscoronary artery diseasemyocardial revascularizationpercutaneous coronary intervention

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