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Coronary Artery Disease and Transcatheter Aortic Valve Replacement
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Abstract
About one-half of transcatheter aortic valve replacement (TAVR) candidates have coronary
artery disease (CAD), and controversial results have been reported regarding the effect
of the presence and severity of CAD on clinical outcomes post-TAVR. In addition to
coronary angiography, promising data has been recently reported on both the use of
computed tomography angiography and the functional invasive assessment of coronary
lesions in the work-up pre-TAVR. While waiting for the results of ongoing randomized
trials, percutaneous revascularization of significant coronary lesions has been the
routine strategy in TAVR candidates with CAD. Also, scarce data exists on the incidence,
characteristics, and management of coronary events post-TAVR, and increasing interest
exist on potential coronary access challenges in patients requiring coronary angiography/intervention
post-TAVR. This review provides an updated overview of the current landscape of CAD
in TAVR recipients, focusing on its prevalence, clinical impact, pre- and post-procedural
evaluation and management, unresolved issues and future perspectives.