Severe Aortic Stenosis and Coronary Artery Disease—Implications for Management in the Transcatheter Aortic Valve Replacement Era
Open accessAbstract
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.
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With the emergence of TAVR, decisions about treating coronary disease have become more complex, including which lesions to treat, how to treat them and when to treat them.
“With the emergence of TAVR, decisions regarding the treatment of coronary disease have become more complex, including which coronary lesions to treat versus leave alone, how to treat them (percutaneous versus bypass) and when to treat them (before, during, or after valve replacement)247.”
From Calcific aortic stenosis (2016) · cites this paper as [247]
The way coronary disease should influence decisions between TAVR and surgical valve replacement is unclear in some scenarios.
“The way in which coronary disease should influence decisions between valve replacement with TAVR versus surgical valve replacement is also unclear in some scenarios.”
From Calcific aortic stenosis (2016) · cites this paper as [247]
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References 65 · Cited by 274
Research works printed but not linked: 2
- [5]5. Goel et al. JACC Vol. 62, No. 1, 2013 Severe Aortic Stenosis and Coronary Disease July 2, 2013:1-10
- [46]46. Khawaja MZ, Asrress KN, Haran H, et al. The effects of pre-existing significant coronary artery disease defined by QCA analysis upon outcome after transcatheter aortic valve implantation using the Edwards bioprosthesis. J Am Coll Cardiol 2011;58 Suppl:B201-2. JACC Vol. 62, No. 1, 2013
- Authors
- Goel, S. S., Ige, M., Tuzcu, E. M., Ellis, S. G., Stewart, W. J., Svensson, L. G., Lytle, B. W., & Kapadia, S. R.
- Affiliations
- Cleveland Clinic (US)
- Corresponding author
- Kapadia, Samir R.
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2013-07
- Volume
- 62
- Issue
- 1
- Pages
- 1-10
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W173091792
- Cited by
- 274
- References
- 65
- Citations by year
- 2026: 11 · 2025: 21 · 2024: 13 · 2023: 17 · 2022: 16 · 2021: 28 · 2020: 32 · 2019: 21 · 2018: 24 · 2017: 25 · 2016: 22 · 2015: 22 · 2014: 20 · 2013: 2
- FWCI
- 3.75
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Aortic Disease and Treatment Approaches
- Keywords
- severe aortic stenosis, coronary artery disease, transcatheter aortic valve implantation, percutaneous coronary intervention, coronary revascularization, timing of revascularization, TAVR outcomes, myocardial ischemia
- MeSH terms
- Animals, Aortic Valve, Aortic Valve Stenosis, Coronary Artery Disease, Cardiac Catheterization, Humans, Severity of Illness Index, Disease Management, Heart Valve Prosthesis Implantation
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