Coronary revascularization and TAVI: before, during, after or never?

O'Sullivan, Crochan John; Stefanini, Giulio; Stortecky, Stefan; Tüller, D; Windecker, Stephan; Wenaweser, Peter Martin (2014). Coronary revascularization and TAVI: before, during, after or never? Minerva medica, 105(6), pp. 475-485. Minerva Medica

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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.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
UniBE Contributor:	O'Sullivan, Crochan John, Stefanini, Giulio, Stortecky, Stefan, Windecker, Stephan, Wenaweser, Peter Martin
Subjects:	600 Technology > 610 Medicine & health
ISSN:	0026-4806
Publisher:	Minerva Medica
Language:	English
Submitter:	Judith Liniger
Date Deposited:	05 May 2015 16:30
Last Modified:	05 Dec 2022 14:39
PubMed ID:	25274461
URI:	https://boris.unibe.ch/id/eprint/61924