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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
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Coronary Revascularization in Patients Undergoing Aortic Valve Replacement for Severe Aortic Stenosis

Kush P Patel1, Michael Michail2, Thomas A Treibel1

  • 1Institute of Cardiovascular Science, University College London, London, United Kingdom; Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom.

JACC. Cardiovascular Interventions
|October 8, 2021
PubMed

Insights

Aortic stenosis and coronary artery disease often coexist, requiring tailored treatment. Aortic valve replacement can improve heart blood flow, but careful assessment of coronary artery disease is crucial for optimal patient outcomes.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Internal Medicine

Background:

  • Aortic stenosis (AS) and coronary artery disease (CAD) frequently coexist, affecting up to two-thirds of AS patients.
  • The presence of both conditions presents significant diagnostic and therapeutic challenges.
  • Myocardial ischemia susceptibility is increased by AS remodeling and can be worsened by concurrent CAD.

Purpose of the Study:

  • To review the impact of AS and aortic valve replacement (AVR) on coronary hemodynamics.
  • To discuss CAD assessment in patients with AS.
  • To evaluate the role of revascularization in patients with concomitant AS and CAD.

Main Methods:

  • Review of existing literature on AS, CAD, and their interactions.
  • Discussion of diagnostic modalities for assessing CAD in AS patients.
  • Analysis of therapeutic strategies, including AVR and coronary revascularization.

Main Results:

  • AVR can positively impact coronary hemodynamic status and reduce myocardial ischemia.
  • Noninvasive and invasive metrics can assess the significance of coexisting CAD.
  • Revascularization may benefit specific patients with prognostically or symptomatically important CAD undergoing AVR.

Conclusions:

  • Patients with both AS and CAD pose complex diagnostic and therapeutic challenges.
  • Understanding the interplay between AS and CAD is essential for treatment decisions.
  • Multidisciplinary team consensus and appropriate coronary assessment are vital for managing these patients.

Keywords:
aortic stenosischronic coronary syndromescoronary artery diseasecoronary hemodynamic statusrevascularization

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