Coronary Revascularisation in Transcatheter Aortic Valve Implantation Candidates: Why, Who, When?

Cao, Davide; Chiarito, Mauro; Pagnotta, Paolo; Reimers, Bernhard

doi:10.15420/icr.2018:2:2

Cited by 24 publications

(24 citation statements)

References 63 publications

(47 reference statements)

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“…The coexistence of AS and coronary artery disease (CAD) is an essential topic to be considered since comorbidities represent the main factor contributing to long‐term prognosis for patients undergoing valve replacement 3 . As atherosclerosis and AS share a significant part of their risk factors, concomitant CAD is often found in patients evaluated for aortic valve replacement, as much as 50% in patients with severe AS, with wide variability among different reports 4‐6 …”

Section: Introductionmentioning

confidence: 99%

Coronary revascularization during treatment of severe aortic stenosis: A meta‐analysis of the complete percutaneous approach (PCI plus TAVR) versus the complete surgical approach (CABG plus SAVR)

Tarus¹,

Tinică

Bacusca³

et al. 2020

J Card Surg

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Background The management of patients with coexisting severe aortic stenosis (AS) and coronary artery disease (CAD) is still facing a great deal of uncertainty when it comes to choosing between the entire surgical versus the complete percutaneous approaches, after accurately balancing risks versus outcomes. Aim To evaluate clinical outcomes and mortality of transcatheter aortic valve replacement (TAVR) plus percutaneous coronary intervention (PCI) compared with surgical aortic valve replacement (SAVR) plus coronary arteries bypass grafting (CABG) procedures in patients with concomitant AS and CAD. Methods Electronic databases of PubMed, EMBASE, and SCOPUS were searched for relevant articles assessing outcome parameters of interest. The study endpoints were the rate of overall myocardial infarction and stroke within 30 days and the rate of 30‐day mortality and 2‐year mortality between patients with TAVR/PCI and those with SAVR/CABG. Results Random‐effect meta‐analysis did not reveal any significant difference between 30‐day safety outcomes: myocardial infarction (TAVR/PCI vs SAVR/CABG: odds ratio [OR]: 0.52; 95% confidence interval [CI]: 0.20‐1.33; I2 = 0%), stroke (TAVR/PCI vs SAVR/CABG: OR: 0.88; 95% CI: 0.45‐1.73; I2 = 0%). No significant difference in 30‐day mortality (OR: 0.72; 95% CI: 0.43‐1.21; I2 = 0%) and 2‐year mortality (OR: 1.50; 95% CI: 0.77‐2.94; I2 = 81%) rate was noted between patients with TAVR/PCI and those with SAVR/CABG. Conclusions When comparing the total percutaneous and total surgical treatment, no significant difference in short‐term safety outcomes or early and late mortality was observed. More evidence is needed to guide the clinical decision.

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Section: Introductionmentioning

confidence: 99%

Coronary revascularization during treatment of severe aortic stenosis: A meta‐analysis of the complete percutaneous approach (PCI plus TAVR) versus the complete surgical approach (CABG plus SAVR)

Tarus¹,

Tinică

Bacusca³

et al. 2020

J Card Surg

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show abstract

“…CAD is common in patients with severe AS, and among patients in the Evolut Low Risk and PARTNER 3 low-risk trials, the baseline history of prior PCI was 13 and 28%, respectively [ 7 , 8 , 107 , 122 ]. In both trials, approximately 7% of patients in the TAVR group underwent concomitant PCI while 13% of patients in the SAVR group underwent coronary artery bypass grafting surgery (CABG).…”

Section: Need For Concomitant Proceduresmentioning

confidence: 99%

Expansion of TAVR into Low-Risk Patients and Who to Consider for SAVR

et al. 2020

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Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of severe aortic stenosis (AS) over the last decade. The results of the Placement of Aortic Transcatheter Valves (PARTNER) 3 and Evolut Low Risk trials demonstrated the safety and efficacy of TAVR in low-surgical-risk patients and led to the approval of TAVR for use across the risk spectrum. Heart teams around the world will now be faced with evaluating a deluge of younger, healthier patients with severe AS. Prior to the PARTNER 3 and Evolut Low Risk studies, this heterogenous patient population would have undergone surgical aortic valve replacement (SAVR). It is unlikely that TAVR will completely supplant SAVR for the treatment of severe AS in patients with a low surgical risk, as SAVR has excellent short- and long-term outcomes and years of durability data. In this review, we outline the critical role that SAVR will continue to play in the treatment of severe AS in the post-PARTNER 3/Evolut Low Risk era.

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“…Whilst, the survival benefit for CABG in patients with stenosis of ≥50% undergoing SAVR is well established, the role of revascularisation in TAVR is more controversial. Recent European guidelines 3 suggest that PCI should be considered in patients with significant stenosis of major epicardial vessels undergoing TAVR with concurrent CAD related to adverse clinical outcomes and impaired survival. However, this poses a dilemma in patients whose CAD is not amenable to PCI, and whose medical comorbidities or technical considerations, such as a calcified aorta, preclude safe SAVR 4 …”

Section: Figurementioning

confidence: 99%

Robotic approach to the porcelain aorta: staged transcatheter aortic valve replacement and robotically assisted coronary artery bypass

Manuel

Fong

Bassin

2020

ANZ Journal of Surgery

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Coronary Revascularisation in Transcatheter Aortic Valve Implantation Candidates: Why, Who, When?

Cited by 24 publications

References 63 publications

Coronary revascularization during treatment of severe aortic stenosis: A meta‐analysis of the complete percutaneous approach (PCI plus TAVR) versus the complete surgical approach (CABG plus SAVR)

Coronary revascularization during treatment of severe aortic stenosis: A meta‐analysis of the complete percutaneous approach (PCI plus TAVR) versus the complete surgical approach (CABG plus SAVR)

Expansion of TAVR into Low-Risk Patients and Who to Consider for SAVR

Robotic approach to the porcelain aorta: staged transcatheter aortic valve replacement and robotically assisted coronary artery bypass

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