Timing and Outcomes of PCI in the TAVR Era
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Purpose of review
Transcatheter aortic valve replacement (TAVR) has become an established therapy for patients with symptomatic severe aortic stenosis (AS). As the number of patients referred for TAVR increases, so does the prevalence of untreated obstructive coronary artery disease (CAD) in the population under evaluation. Despite the high prevalence of CAD in patients treated with TAVR, the management strategy of concomitant CAD in these patients remains an area of considerable uncertainty.
Percutaneous coronary intervention (PCI) in patients with CAD and severe AS has been shown to be feasible and safe. Whether revascularization before, during, or after TAVR is optimal remains a subject of debate. All three approaches represent valid strategies with advantages and disadvantages that need to be carefully weighed on an individual basis.
Current expert opinions recommend that PCI should be performed before or at the time of TAVR as long as the risk of the procedure does not outweigh the potential benefits. The results of large clinical trials evaluating the optimal revascularization time are closely awaited.
KeywordsTAVR PCI CAD Coronary artery disease
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: •• Of major importance
- 15.Puymirat, E., et al. Impact of coronary artery disease in patients undergoing transcatheter aortic valve replacement: Insights from the FRANCE-2 registry. Clin Cardiol. 2017.Google Scholar
- 16.Sankaramangalam K, et al. Impact of coronary artery disease on 30-day and 1-year mortality in patients undergoing transcatheter aortic valve replacement: a meta-analysis. J Am Heart Assoc. 2017 6(10).Google Scholar
- 18.Paradis JM et al. Impact of coronary artery disease severity assessed with the SYNTAX score on outcomes following transcatheter aortic valve replacement. J Am Heart Assoc. 2017. 6(2).Google Scholar
- 22.•• Ramee S, et al. The rationale for performance of coronary angiography and stenting before transcatheter aortic valve replacement: from the Interventional Section Leadership Council of the American College of Cardiology. JACC: Cardiovasc Interv. 2016;9(23):2371–5. A report from the Interventional Section Leadership Council of the American College of Cardiology proposing an algorithm to evaluate TAVR candidates with CAD.Google Scholar
- 25.Millan-Iturbe O et al. Coronary artery disease, revascularization, and clinical outcomes in transcatheter aortic valve replacement: real-world results from the East Denmark Heart Registry. Catheter Cardiovasc Interv. 2017.Google Scholar
- 35.Kotronias RA et al. Transcatheter aortic valve implantation with or without percutaneous coronary artery revascularization strategy: a systematic review and meta-analysis. J Am Heart Assoc. 2017. 6(6).Google Scholar
- 36.Barbanti M et al. Optimized screening of coronary artery disease with invasive coronary angiography and ad hoc percutaneous coronary intervention during transcatheter aortic valve replacement. Circ Cardiovasc Interv, 2017. 10(8).Google Scholar