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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
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Prognostic impact of coronary artery disease in patients undergoing transcatheter aortic valve replacement

Max B Sayers1, Krishnaraj Rathod2, Mohammed Akhtar3

  • 1Barts Heart Centre, West Smithfield, London, United Kingdom; Cutrale Perioperative Ageing Group, Department of Bioengineering, Imperial College London, London, United Kingdom.

Cardiovascular Revascularization Medicine : Including Molecular Interventions
|May 17, 2025
PubMed

Insights

Coronary artery disease burden does not affect transcatheter aortic valve replacement safety but higher burdens correlate with increased long-term mortality and myocardial infarction risk. Further research into managing coronary artery disease in TAVR patients is warranted.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Prognostic implications of coronary artery disease (CAD) in severe aortic stenosis (AS) patients undergoing transcatheter aortic valve replacement (TAVR) are not fully understood.
  • Assessing CAD's impact on TAVR safety and long-term outcomes is crucial for patient management.

Purpose of the Study:

  • To evaluate the effect of varying coronary artery disease burdens on the safety and long-term prognosis of patients undergoing TAVR.
  • To determine if CAD severity influences procedural outcomes and subsequent adverse cardiovascular events.

Main Methods:

  • Retrospective analysis of 1803 patients undergoing TAVR, stratified by CAD burden (low, intermediate, high) based on angiographic findings.
  • Primary endpoint: all-cause mortality. Secondary endpoints included cardiovascular death, myocardial infarction (MI), heart failure hospitalization (HHF), and major adverse coronary events (MACE).

Main Results:

  • No significant differences in procedural safety or in-hospital mortality were observed across CAD burden groups.
  • At median 4.8-year follow-up, high-burden CAD was linked to increased all-cause mortality (HR 1.35), cardiovascular death (HR 1.54), and MACE (HR 1.63).
  • Both intermediate and high CAD burden groups showed a significantly higher incidence of MI (HRs 2.87 and 2.69, respectively).

Conclusions:

  • Coronary artery disease burden does not compromise TAVR procedural safety, suggesting revascularization is not a mandatory prerequisite.
  • High CAD burden is associated with poorer long-term outcomes, including mortality and MACE.
  • Patients with high CAD burden undergoing TAVR may benefit from targeted strategies for CAD management.
Abstract

Keywords:
Aortic stenosisCoronary artery diseaseRevascularizationRisk stratificationTranscatheter aortic valve replacement

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