Coronary Artery Disease and Transcatheter Aortic Valve Replacement

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Concomitant severe aortic stenosis (AS) and coronary artery disease (CAD) are common in patients considered for transcatheter aortic valve replacement (TAVR).
• Invasive coronary angiography is standard for CAD assessment, with coronary CT angiography useful for low-risk patients.
• Functional assessment of coronary lesions is safe with AS, but its impact on results requires further study.

Purpose of the Study:

• To review the current understanding of managing concomitant CAD and AS in TAVR candidates.
• To discuss the optimal timing and techniques for percutaneous coronary intervention (PCI) in relation to TAVR.
• To highlight considerations for future coronary access after TAVR.

Main Methods:

• Review of existing literature on CAD management in TAVR patients.
• Analysis of data regarding functional testing in the presence of AS.
• Evaluation of outcomes associated with revascularization timing and PCI strategies post-TAVR.

Main Results:

• Revascularization of significant CAD (≥90% stenosis, FFR ≤0.80) improves outcomes compared to medical therapy.
• No clear benefit exists for revascularization before TAVR; optimal timing remains uncertain.
• Short-frame valves facilitate better coronary access after TAVR, crucial for planned or future PCI.

Conclusions:

• Careful planning for PCI, considering valve type and future access, is essential for TAVR patients with CAD.
• The increasing prevalence of TAVR in younger patients and deferred revascularization will likely increase post-TAVR PCI procedures.
• Individualized strategies are needed to optimize management of combined AS and CAD.