Author + information
- Received May 28, 2019
- Accepted June 10, 2019
- Published online July 15, 2019.
- Laurent Faroux, MD, MSc,
- Leonardo Guimaraes, MD,
- Jérôme Wintzer-Wehekind, MD,
- Lucia Junquera, MD,
- Alfredo Nunes Ferreira-Neto, MD,
- David del Val, MD,
- Guillem Muntané-Carol, MD,
- Siamak Mohammadi, MD,
- Jean-Michel Paradis, MD and
- Josep Rodés-Cabau, MD∗ (, )@IUCPQ
- ↵∗Address for correspondence:
Dr. Josep Rodés-Cabau, Quebec Heart & Lung Institute, Laval University, 2725 Chemin Ste-Foy, Quebec City, Quebec G1V4G5, Canada.
• The impact of CAD in TAVR recipients remains controversial, and no definite data exist on the most appropriate revascularization strategy in these patients.
• The use of CTA and hemodynamic assessment to guide pre-TAVR revascularization will likely increase in the coming years.
• The management of coronary events occurring after TAVR (including coronary access) requires further investigations.
About one-half of transcatheter aortic valve replacement (TAVR) candidates have coronary artery disease (CAD), and controversial results have been reported regarding the effect of the presence and severity of CAD on clinical outcomes post-TAVR. In addition to coronary angiography, promising data has been recently reported on both the use of computed tomography angiography and the functional invasive assessment of coronary lesions in the work-up pre-TAVR. While waiting for the results of ongoing randomized trials, percutaneous revascularization of significant coronary lesions has been the routine strategy in TAVR candidates with CAD. Also, scarce data exists on the incidence, characteristics, and management of coronary events post-TAVR, and increasing interest exist on potential coronary access challenges in patients requiring coronary angiography/intervention post-TAVR. This review provides an updated overview of the current landscape of CAD in TAVR recipients, focusing on its prevalence, clinical impact, pre- and post-procedural evaluation and management, unresolved issues and future perspectives.
Dr. Faroux was supported by a grant from Institut Servier; and has received research grants from Biotronik, Edwards Lifesciences, and Medtronic. Drs. Junquera, del Val, and Muntané-Carol were supported by a grant from the Fundacion Alfonso Martin Escudero (Madrid, Spain). Dr. Rodés-Cabau holds the Research Chair “Fondation Famille Jacques Larivière” for the Development of Structural Heart Disease Interventions; and has received institutional research grants from Edwards Lifesciences, Medtronic, and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received May 28, 2019.
- Accepted June 10, 2019.
- 2019 American College of Cardiology Foundation
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