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.