Coronary Artery Disease and Transcatheter Aortic Valve Replacement

Management of valvular and structural heart diseases during the coronavirus disease 2019 pandemic: an expert opinion of the Working Group on Valvular Heart Diseases, the Working Group on Cardiac Surgery, and the Association of Cardiovascular Interventions of the Polish Cardiac Society

“…The group at higher risk should include patients with severe symptomatic AS and: decreased left ventricular ejection fraction (LVEF), symptomatic heart failure (HF) classified as the New York Heart Association (NYHA) class III to IV, syncope secondary to AS, and a high or very high transvalvular gradient. 16 This group requires an urgent intervention or balloon aortic valvuloplasty may be considered in this population.…”

Exposure to Ionizing Radiation in Patients Undergoing Transfemoral Transcatheter Aortic Valve Implantation

“…Prospective gating for the chest portion of the CT scan, 18 dual source multidetector CT-angiography using a high-pitch spiral acquisition mode 19,20 and the use of an automated tube voltage selection 21 have promising clinical data. Finally, CT remains the cornerstone of the pre-TAVI work-up since it provides information about annulus size, peripheral access, coexisting coronary artery disease, 22 and the calcium score, particularly in paradoxical low-flow low-gradient aortic stenosis. 2,3 In the present study, mean DAP during TAVI procedures was about 2000 cGy.cm 2 whereas several studies reported a higher DAP, between 5000 and 10000 cGy.cm 2 .…”

“…We thus provide an estimation of the overall ED received by the patients, which has never previously been reported, to the best of our knowledge. Coronary CT has emerged as a reasonable alternative to coronary angiography for the evaluation of coronary artery disease pre-TAVI, 22 and some centers decide to perform a pre-TAVI coronary angiography depending on patient's history, symptoms, and pre-TAVI coronary CT findings. In our study, all patients benefited from a pre-TAVI coronary angiography, thus we may slightly overestimate the overall ED.…”

Transcatheter Aortic Valve Implantation Current Indications and Future Directions

“…Over the last 17 years, TAVR has evolved from a procedure in well-selected very-high risk patients to a first choice treatment for the majority of patients with symptomatic severe aortic stenosis, whereas surgical treatment will remain to be discussed, including the following clinical scenarios or anatomical specifications: Coronary artery disease (CAD) is the most common comorbid condition in patients eligible for TAVR. Owing to the continuous decline of surgical risk profile over time, a significant decrease in CAD prevalence was observed (23). Nevertheless, careful attention should be given to the severity of CAD during the pre-evaluation and the screening for a TAVR procedure, as the complexity of CAD was independently associated with cardiac mortality during the first 12 months after TAVR (24).…”