Management of concomitant coronary artery disease and aortic valve stenosis in the era of transcatheter aortic valve treatment

Abstract

Severe calcific aortic stenosis (AS) and coronary artery disease (CAD) have common risk factors and are frequently encountered in the same patient in clinical practice. CAD has been reported in ≥ 50% of AS patients undergoing both surgical treatment and transcatheter aortic valve implantation (TAVI). In the last two decades, TAVI has been established as a less invasive alternative to surgery. Recently, more and more young and low surgical risk patients undergo TAVI. Despite the high prevalence of CAD in patients treated with TAVI, the management strategy of concomitant CAD in these patients remains an area of considerable uncertainty. This review provides an updated overview of the current knowledge about this topic and offers points for reflection about the best approach to use.

Impact of TAVR on coronary artery hemodynamics using clinical measurements and image‐based patient‐specific in silico modeling

“…There is currently uncertainty around the optimal management and treatment of AS and coexisting CAD 95 . There is a current debate about whether CAD should be treated before AS, alongside the AS or after the AS 19 , 91 , 96 .…”

Complete transcatheter versus complete surgical management for combined aortic stenosis and coronary artery disease: A false dichotomy?

“…Given the overlap in risk factors for aortic stenosis (AS) and coronary artery disease (CAD), these conditions commonly occur in concomitance. 1 Recent year has witnessed the growing cardiovascular indications for which transcatheter procedures are studied and utilized, including combined AS and CAD with transcatheter aortic valve implantation (TAVI) and percutaneous coronary intervention (PCI). However, significantly more data, both in volume and in the length of follow-up, are available for the conventional surgical approaches for such patients including combined surgical aortic valve replacement (SAVR) and coronary artery bypass grafting (CABG).…”

“…Given the overlap in risk factors for aortic stenosis (AS) and coronary artery disease (CAD), these conditions commonly occur in concomitance 1 . Recent year has witnessed the growing cardiovascular indications for which transcatheter procedures are studied and utilized, including combined AS and CAD with transcatheter aortic valve implantation (TAVI) and percutaneous coronary intervention (PCI).…”

Evaluation and management of coronary artery disease in patients undergoing transcatheter aortic valve implantation

“…Per American College of Cardiology/American Heart Association guidelines, TAVI is preferred for surgical aortic valve replacement in patients aged > 80 years, patients with a life expectancy < 10 years, or patients who are at high surgical risk [5] . However, as TAVI has been extended to low-risk patients -given patient preference and improved safety -TAVI is becoming the preferred treatment in younger patients who are at intermediate and even low surgical risk for aortic valve replacement [6,7] . These patients have a longer life expectancy and are more likely to develop obstructive CAD or have a progression of underlying CAD that may not have been significant at the time of TAVI.…”