Aortic Stenosis With Coronary Artery Disease: SAVR or TAVR—When and How?

医学 心脏病学 传统PCI 内科学 血运重建 狭窄 冠状动脉疾病 主动脉瓣置换术 阀门更换 经皮冠状动脉介入治疗 冲程(发动机) 主动脉瓣狭窄 射血分数 外科 心肌梗塞 心力衰竭 机械工程 工程类
作者
Juan Portillo,Julio I. Farjat‐Pasos,Attílio Galhardo,Marisa Avvedimento,Silvia Mas‐Peiró,Siddhartha Mengi,Jorge Nuche,Siamak Mohammadi,Josep Rodés‐Cabau
出处
期刊:Canadian Journal of Cardiology [Elsevier]
卷期号:40 (2): 218-234 被引量:1
标识
DOI:10.1016/j.cjca.2023.09.023
摘要

The growing number of candidates for transcatheter aortic valve replacement (TAVR) has increased the interest in the concomitant presence of coronary artery disease (CAD) and severe aortic stenosis (AS), prompting the need to define the appropriate revascularization strategy for each case. The reported prevalence of concurrent AS and CAD has varied over the years on the basis of the CAD definition and the population evaluated. Revascularization for treating CAD in patients with severe AS involves additional interventions that could impact outcomes. The addition of coronary artery bypass grafting (CABG) to surgical aortic valve replacement (SAVR) has demonstrated favourable effects on long-term prognosis, while the impact of adding percutaneous coronary intervention (PCI) to TAVR may depend on the CAD complexity and the feasibility of achieving complete or reasonably incomplete revascularization. Furthermore, the comparison between SAVR+CABG and TAVR+PCI in low-intermediate surgical risk and low-intermediate complex CAD patients did not reveal differences in all-cause mortality or stroke between the groups. However, there is some evidence showing a lower incidence of major cardiovascular events with the SAVR+CABG strategy for patients with complex CAD. Thus, SAVR+CABG seems to be the best option for patients with low-intermediate surgical risk and complex CAD, and TAVR+PCI for high surgical risk patients seeking complete and/or reasonable incomplete revascularization. After deciding between TAVR+PCI or SAVR+CABG, factors such as timing for PCI, low ejection fraction, coronary reaccess, and valve durability must be considered. Finally, alternative methods for assessing CAD severity are currently under evaluation to ascertain their real value for guiding revascularization in patients with severe AS with CAD.
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