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Revascularization in the Transcatheter Aortic Valve Replacement Population

Mohammad Alkhalil1, Ahmad Jabri2, Rishi Puri3

  • 1Department of Cardiothoracic Services, Freeman Hospital, Newcastle-upon-Tyne NE7 7DN, UK; Vascular Biology, Newcastle University, Newcastle-upon-Tyne NE7 7DN, UK.

Interventional Cardiology Clinics
|October 1, 2021
PubMed

Insights

Transcatheter aortic valve replacement (TAVR) for severe aortic stenosis is standard, but managing coronary artery disease (CAD) concurrently is debated. This review discusses the prognostic impact of CAD in TAVR patients.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Transcatheter aortic valve replacement (TAVR) is a primary treatment for severe aortic stenosis.
  • Management of concurrent coronary artery disease (CAD) in TAVR patients lacks definitive guidance from randomized trials.
  • Defining and assessing CAD in this population presents challenges due to heterogeneity.

Purpose of the Study:

  • To review the rationale and prognostic significance of coronary artery disease (CAD) in patients undergoing transcatheter aortic valve replacement (TAVR).
  • To explore the complexities surrounding the management of concomitant CAD in the context of TAVR.
  • To highlight the individualized approach to coronary revascularization decisions by heart teams.

Main Methods:

  • Literature review and discussion of existing evidence.
  • Analysis of the prognostic role of CAD in TAVR candidates.
  • Examination of diagnostic and definitional heterogeneity of CAD.

Main Results:

  • The role and impact of CAD in TAVR patients are not fully elucidated.
  • Current decision-making for coronary revascularization is individualized.
  • Lack of standardized methods for CAD assessment complicates evaluation.

Conclusions:

  • The prognostic implications of CAD in TAVR patients warrant further investigation.
  • A case-by-case assessment by heart teams is crucial for managing concomitant CAD.
  • Future research is needed to standardize CAD assessment and guide treatment strategies.

Keywords:
Aortic stenosisCoronary artery diseasePercutaneous coronary interventionTranscatheter aortic valve replacement

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