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Management of Coronary Artery Disease in the Setting of Transcatheter Aortic Valve Replacement

Natraj Katta1, J Dawn Abbott2, Ankur Kalra3

  • 1University of Nebraska Medical Center, Omaha, NE, USA.

Heart International
|October 24, 2022
PubMed

Insights

The best way to treat coronary artery disease (CAD) in patients undergoing transcatheter aortic valve replacement (TAVR) is unclear. More research is needed to determine if CAD revascularization improves outcomes after TAVR.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Aortic stenosis and coronary artery disease (CAD) often coexist due to shared risk factors and pathophysiology.
  • Optimal management of CAD in patients undergoing transcatheter aortic valve replacement (TAVR) is uncertain due to limited evidence.

Purpose of the Study:

  • To review the current evidence regarding CAD revascularization in patients undergoing TAVR.
  • To highlight the need for further research, specifically randomized controlled trials (RCTs), to guide clinical decision-making.

Main Methods:

  • Review of observational studies and meta-analyses on outcomes of CAD revascularization in TAVR patients.
  • Analysis of factors influencing outcomes, such as residual SYNTAX score (rSS).

Main Results:

  • Existing studies show varied results; no significant difference in post-TAVR outcomes between revascularized and non-revascularized patients.
  • Some evidence suggests lower rSS post-revascularization may correlate with better TAVR outcomes.

Conclusions:

  • The benefit of CAD revascularization in TAVR patients remains inconclusive.
  • Individualized treatment decisions based on heart team consultation are recommended in the absence of definitive RCT data.

Keywords:
Aortic stenosis (AS)coronary artery disease (CAD)heart teamrevascularisationtranscatheter aortic valve replacement (TAVR)

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