Impact of Coronary Artery Revascularization Completeness on Outcomes of Patients With Coronary Artery Disease Undergoing Transcatheter Aortic Valve Replacement

Witberg, Guy; Zusman, Oren; Codner, Pablo; Assali, Abid; Kornowski, Ran

doi:10.1161/circinterventions.117.006000

Cited by 57 publications

(13 citation statements)

References 33 publications

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“…While a meta-analysis of 7 studies (2,472 patients) did not prove a mid-term effect of CAD on TAVR outcomes (116), a more recent one (15 studies, 8,013 patients) has shown no impact on 30-days mortality but a significant adverse impact on 1-year mortality (OR 1.21; 95% CI, 1.07-1.36; P=0.002) (117). In a third meta-analysis (6 studies, 3,107 patients), a residual SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery)-score cut-off value (<8) after coronary revascularization has been shown to predict a significantly higher mortality (OR 1.69; 95% CI, 1.26-2.28; P<0.001) (118). The eagerly awaited results from the ACTIVATION trial (ISRCTN75836930) (119) will help to establish recommendations about the need and appropriate extent of CAD revascularization prior to TAVR.…”

Section: Tavr and Cardiac Ischemic Diseasementioning

confidence: 99%

Current issues in transcatheter aortic valve replacement

et al. 2020

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Background: aortic stenosisAortic stenosis (AS) is one of the most common forms of valvular disease in Western countries (1-3). It shows a consistent association with age, with prevalence ranging from 0.2% in the 50-59-year group to 9.8% in the 80-89-year cohort (4). Its prevalence is expected to increase due to higher life expectancy and population aging (5,6). It is also the most common reason for heart valve replacement (7).In a recent editorial paper (8), Eugene Braunwald put in perspective the medical advances in severe AS therapy over the last 50 years since the publication of his seminal study on AS natural history (9). Patients with severe AS had a good survival during a long latency period with "increasing obstruction and myocardial overload" until being about 60 years old. Then severe symptoms appeared and survival was poor, with most patients having heart failure, syncope and/or angina, and dying in a few years. With surgery being then the only available etiological treatment, the aim was to identify the patients approaching to such turning point to recommend surgery even with its associated risk with early prostheses.Even though this typical course has been confirmed over the years (10-12), the survival curve has shown a clear-cut shift to the right with progressive symptoms appearing now in patients in their 7th to 9th decade (6). Medical advances have now led most AS patients to what Braunwald calls a "promised land" with a long survival and good quality

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Section: Tavr and Cardiac Ischemic Diseasementioning

confidence: 99%

Current issues in transcatheter aortic valve replacement

et al. 2020

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“…A recent pooled analysis demonstrated that patients undergoing TAVR with higher residual SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score were at risk of greater subsequent mortality. 65 The importance of correctly identifying ischaemia-inducing lesions in such patients prompted the recent exploration of pressure-based indices in these cohorts. While the feasibility of both FFR and iFR has been demonstrated in such patients, there are concerns that the altered ventriculo-aortic physiology distorts their accuracy.…”

Section: Special Patient and Lesion Subgroupsmentioning

confidence: 99%

Non-hyperaemic pressure ratios to guide percutaneous coronary intervention

et al. 2020

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The use of fractional flow reserve (FFR) in guiding revascularisation improves patient outcomes and has been well-established in clinical guidelines. Despite this, the uptake of FFR has been limited, likely attributable to the perceived increase in procedural time and use of hyperaemic agents that can cause patient discomfort. This has led to the development of instantaneous wave-free ratio (iFR), an alternative non-hyperaemic pressure ratio (NHPR). Since its inception, the use of iFR has been supported by an increasing body of evidence and is now guideline recommended. More recently, other commercially available NHPRs including diastolic hyperaemia-free ratio and resting full-cycle ratio have emerged. Studies have demonstrated that these indices, in addition to mean distal coronary artery pressure to mean aortic pressure ratio, are mathematically analogous (with specific nuances) to iFR. Additionally, there is increasing data demonstrating the equivalent diagnostic performance of alternative NHPRs in comparison with iFR and FFR. These NHPRs are now integral within most current pressure wire systems and are commonly available in the catheter laboratory. It is therefore key to understand the fundamental differences and evidence for NHPRs to guide appropriate clinical decision-making.

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“…Using the residual SYNTAX score (rSS), a previous meta-analysis has shown that patients with a higher rSS have increased mortality after TAVI, suggesting the negative impact of incomplete coronary revascularisation. [ 8 , 45 ] Although these findings are contradictory and should be evaluated in the context of the presence of ischaemia, it is important to provide complete revascularisation in such patients undergoing TAVI, at least in the main vessels/territories. [ 46 ]…”

Section: Intervention In Tavi Patientsmentioning

confidence: 99%

Coronary Artery Disease in Patients with Aortic Stenosis and Transcatheter Aortic Valve Implantation: Implications for Management

Filho¹,

Accorsi

Ribeiro

2021

Eur Cardiol

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Aortic valve stenosis (AS) is the most common valvular heart disease among elderly patients. Since the pathophysiology of degenerative AS shares common pathways with atherosclerotic disease, the severity of AS in the elderly population is often concurrent to the presence of coronary artery disease (CAD). Although surgical aortic valve replacement has been the standard treatment for severe AS, the high operative morbidity and mortality in complex and fragile patients was the trigger to develop less invasive techniques. Transcatheter aortic valve implantation (TAVI) has been posed as the standard of care for elderly patients with severe AS with various risk profiles, which has meant that the concomitant management of CAD has become a crucial issue in such patients. Given the lack of randomised controlled trials evaluating the management of CAD in TAVI patients, most of the recommendations are based on retrospective cohort studies so that the Heart Team approach – together with an assessment of multiple parameters including symptoms and clinical characteristics, invasive and non-invasive ischaemic burden and anatomy – are crucial for the proper management of these patients. This article provides a review of current knowledge about assessment and therapeutic approaches for CAD and severe AS in patients undergoing TAVI.

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Impact of Coronary Artery Revascularization Completeness on Outcomes of Patients With Coronary Artery Disease Undergoing Transcatheter Aortic Valve Replacement

Cited by 57 publications

References 33 publications

Current issues in transcatheter aortic valve replacement

Current issues in transcatheter aortic valve replacement

Non-hyperaemic pressure ratios to guide percutaneous coronary intervention

Coronary Artery Disease in Patients with Aortic Stenosis and Transcatheter Aortic Valve Implantation: Implications for Management

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