title: Severe aortic stenosis and coronary artery disease--implications for management in the transcatheter aortic valve replacement era: a comprehensive review.
abstract: Management of coronary artery disease (CAD) in patients with severe aortic stenosis (AS) referred for transcatheter aortic valve replacement (TAVR) is posing challenges. Due to limited and heterogeneous data on the prevalence and clinical impact of CAD on the outcomes of TAVR and the management strategies for CAD in patients undergoing TAVR, we performed a comprehensive review of the literature. Significant CAD is present in 40% to 75% of patients undergoing TAVR. The impact of CAD on outcomes after TAVR remains understudied. Based on existing data, not all patients require revascularization before TAVR. Percutaneous coronary intervention (PCI) should be considered for severely stenotic lesions in proximal coronaries that subtend a large area of myocardium at risk. Ongoing studies randomizing patients to surgical or percutaneous management strategies for severe AS will help provide valuable data regarding the impact of CAD on TAVR outcomes, the role of PCI, and its timing in relation to TAVR.
authors: Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors: Sachin S
authors: SS
authors: Goel
authors: Mobolaji
authors: M
authors: Ige
authors: E Murat
authors: EM
authors: Tuzcu
authors: Stephen G
authors: SG
authors: Ellis
authors: William J
authors: WJ
authors: Stewart
authors: Lars G
authors: LG
authors: Svensson
authors: Bruce W
authors: BW
authors: Lytle
authors: Samir R
authors: SR
authors: Kapadia
mesh_terms: D000818:Animals; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D006328:Cardiac Catheterization / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D019468:Disease Management; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D012720:Severity of Illness Index