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The Management of Coronary Artery Disease in TAVR Patients

Laurent Faroux1, Aurélien Villecourt1, Damien Metz1

  • 1Cardiology Department, Reims University Hospital, 51100 Reims, France.

Journal of Clinical Medicine
|November 25, 2023
PubMed

Insights

Coronary artery disease (CAD) is common in transcatheter aortic valve replacement (TAVR) patients, impacting outcomes. This review covers CAD evaluation, management, and outcomes before and after TAVR.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Imaging

Background:

  • Coronary artery disease (CAD) affects approximately 50% of patients undergoing transcatheter aortic valve replacement (TAVR).
  • The impact of CAD on clinical outcomes post-TAVR remains controversial.
  • Current pre-TAVR work-up includes coronary angiography, cardiac CT angiography, and functional assessments like FFR or iFR.

Purpose of the Study:

  • To provide an updated overview of coronary artery disease in TAVR recipients.
  • To focus on the prevalence, clinical impact, and evaluation/management strategies for CAD in this population.
  • To address knowledge gaps regarding post-TAVR coronary events and access challenges.

Main Methods:

  • Review of current literature on CAD in TAVR patients.
  • Analysis of diagnostic modalities including coronary angiography, cardiac CT angiography, FFR, and iFR.
  • Examination of management strategies for CAD pre- and post-TAVR.

Main Results:

  • CAD is prevalent in TAVR recipients, with debated effects on outcomes.
  • Percutaneous revascularization is standard for significant CAD in TAVR candidates.
  • Limited data exists on post-TAVR coronary events and potential access issues.

Conclusions:

  • Understanding CAD prevalence and impact is crucial for TAVR outcomes.
  • Comprehensive pre-procedural evaluation and tailored management are essential.
  • Further research is needed on post-TAVR coronary events and interventions.

Keywords:
TAVRcoronary artery diseasecoronary computed tomography angiographyfractional flow reserve

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