IMR Press / RCM / Volume 24 / Issue 3 / DOI: 10.31083/j.rcm2403068
Open Access Review
Unravelling the Fate of Coronary Artery Disease in Patients Undergoing Valve Replacement for Severe Aortic Valve Stenosis
Show Less
1 Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
2 Department of Cardiovascular Medicine, University Hospitals Leuven (UZLeuven), 3000 Leuven, Belgium
*Correspondence: Lennert.minten@gmail.com (Lennert Minten)
Rev. Cardiovasc. Med. 2023, 24(3), 68; https://doi.org/10.31083/j.rcm2403068
Submitted: 17 December 2022 | Revised: 6 January 2023 | Accepted: 10 January 2023 | Published: 23 February 2023
Copyright: © 2023 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.
Abstract

Severe aortic valve stenosis is the most frequent valve pathology in the western world and approximately 50% of these patients have concomitant coronary artery disease (CAD). Revascularization of proximal obstructive CAD in patients undergoing surgical aortic valve replacement (SAVR) is common practice considered appropriate. However, the management of patients with CAD undergoing transcatheter aortic valve implantation (TAVI) is more controversial. Nevertheless, performing percutaneous coronary intervention (PCI) of significant (>70%) proximal coronary lesions is a widely adopted strategy, but robust supporting scientific evidence is missing. Some studies suggest that complex CAD with incomplete revascularization negatively impacts outcomes post-TAVI. As increasingly younger patients are undergoing TAVI, optimizing the long-term outcomes will become more important. Although PCI in TAVI patients is safe, no benefit on outcomes has been demonstrated, possibly due to an inadequate selection of prognostically important lesions for revascularization. A possible solution might be the use of coronary physiological indices, but these have their own limitations and more data is needed to support widespread adoption. In this review we provide an overview of current evidence on the outcomes after aortic valve replacement (AVR) and the evidence regarding revascularization in this population.

Keywords
coronary artery disease
aortic valve stenosis
percutaneous coronary intervention
transcatheter aortic valve implantation
Funding
1194521/Research Foundation Flanders
489686/Belgian Fund For Heart surgery
Figures
Fig. 1.
Share
Back to top