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Percutaneous Coronary Intervention in Transcatheter Aortic Valve Implantation Patients: Overview and Practical

Maren Weferling1,2, Christian W Hamm1,2,3, Won-Keun Kim1,2,3,4

  • 1Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.

Frontiers in Cardiovascular Medicine
|May 21, 2021
PubMed

Insights

Coronary artery disease (CAD) is common in patients receiving transcatheter aortic valve implantation (TAVI). This review examines the role of percutaneous coronary intervention (PCI) in TAVI patients, offering guidance for clinical practice.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Coronary artery disease (CAD) affects a significant portion (40-75%) of patients undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis.
  • The expanding indications for TAVI in younger, lower-risk patients suggest an increased future need for coronary interventions.
  • Current guidelines recommend percutaneous coronary intervention (PCI) before TAVI, but optimal timing lacks robust evidence.

Purpose of the Study:

  • To review the prevalence and clinical impact of CAD in TAVI patients.
  • To discuss the challenges and implications of performing coronary angiography (CA) and PCI in the context of TAVI.
  • To provide practical guidance for managing CAD and PCI in TAVI recipients.

Main Methods:

  • Literature review of current data on CAD and PCI in TAVI patients.
  • Analysis of European and US guidelines regarding PCI timing.
  • Discussion of technical considerations for CA and PCI post-TAVI.

Main Results:

  • CAD is highly prevalent in TAVI candidates, necessitating careful management.
  • The optimal timing for PCI relative to TAVI remains controversial due to limited evidence.
  • Post-TAVI coronary procedures can be technically challenging depending on the prosthetic valve.

Conclusions:

  • Interventionalists must be knowledgeable about transcatheter heart valves to navigate potential complications during coronary procedures.
  • Further research is needed to establish optimal timing for PCI in TAVI patients.
  • This review offers insights for practical management of CAD in the TAVI population.

Keywords:
PCITAVIacute coronary syndromecoronary angiographycoronary artery disease

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