title: Coronary revascularization and TAVI: before, during, after or never?
abstract: Aortic valve stenosis and coronary artery disease (CAD) frequently coexist in elderly patients selected for transcatheter aortic valve implantation (TAVI). Therapeutic strategies to manage concomitant obstructive CAD are therefore an important consideration in the overall management of patients with severe aortic stenosis (AS) undergoing TAVI. Conventional surgical aortic valve replacement and coronary artery bypass grafting is the treatment of choice for low and intermediate risk patients with symptomatic severe AS and concomitant obstructive CAD. However, TAVI and percutaneous coronary intervention (PCI) are viable alternative options for high-risk or inoperable patients presenting with symptomatic severe AS. PCI has been shown to be feasible and safe in selected high-risk or inoperable patients with symptomatic severe AS. However, the optimal timing of PCI relative to the TAVI procedure has been a subject of debate. The most frequent approch is staged PCI typically performed a few weeks prior to TAVI. However, concomitant PCI has also been shown to be a feasible and safe approach, particularly in patients with a low level of CAD complexity and an absence of severe renal impairment. Conversely, staged PCI should be considered in patients with higher degrees of CAD complexity, particularly in the presence of severe renal impairment. The aim of the present review is to discuss the safety and feasibility of performing PCI in elderly patients with severe AS and the optimal timing of PCI relative to the TAVI procedure using the most up-to-date available evidence.
authors.affiliation: Department of Cardiology Bern University Hospital, Bern, Switzerland - peter.wenaweser@insel.ch.
authors.forename: C J
authors.initials: CJ
authors.lastname: O'Sullivan
authors.forename: G G
authors.initials: GG
authors.lastname: Stefanini
authors.forename: S
authors.initials: S
authors.lastname: Stortecky
authors.forename: D
authors.initials: D
authors.lastname: Tüller
authors.forename: S
authors.initials: S
authors.lastname: Windecker
authors.forename: P
authors.initials: P
authors.lastname: Wenaweser
mesh_terms: D000465:Algorithms; D001024:Aortic Valve Stenosis / Q000150:complications / Q000601:surgery*; D000075202:Contraindications; D001026:Coronary Artery Bypass; D023921:Coronary Stenosis / Q000150:complications / Q000601:surgery*; D054855:Drug-Eluting Stents; D005471:Fluoroscopy; D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000503:physiopathology; D015201:Meta-Analysis as Topic; D015337:Multicenter Studies as Topic; D064887:Observational Studies as Topic; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011446:Prospective Studies; D015641:Radiography, Interventional; D016032:Randomized Controlled Trials as Topic; D012042:Registries; D012720:Severity of Illness Index; D015607:Stents; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D016896:Treatment Outcome