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Management of coronary artery disease in patients with aortic stenosis
  1. Vitaliy Androshchuk,
  2. Tiffany Patterson,
  3. Simon R Redwood
  1. Rayne Institute, BHF Centre of Research Excellence, King's College London, St Thomas' Hospital, Guy's and St Thomas' Hospitals NHS Trust, London, UK
  1. Correspondence to Dr Vitaliy Androshchuk, Rayne Institute, BHF centre of research excellence, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom, SE1 7EH., Guy's and St Thomas' NHS Foundation Trust, London, UK; vitaliy.androshchuk{at}gstt.nhs.uk

Abstract

Aortic stenosis (AS) is the most common valvular heart disorder in the elderly population. As a result of the shared pathophysiological processes, AS frequently coexists with coronary artery disease (CAD). These patients have traditionally been managed through surgical aortic valve replacement (SAVR) and coronary artery bypass grafting. However, increasing body of evidence supports transcatheter aortic valve implantation (TAVI) as an alternative treatment for severe AS across the spectrum of operative risk. This has created the potential for treating AS and concurrent CAD completely percutaneously. In this review we consider the evidence guiding the optimal management of patients with severe AS and CAD. While invasive coronary angiography plays a central role in detecting CAD in patients with AS undergoing surgery or TAVI, the benefits of complementary functional assessment of coronary stenosis in the context of AS have not been fully established. Although the indications for revascularisation of significant proximal CAD in SAVR patients have not recently changed, routine revascularisation of all significant CAD before TAVI in patients with minimal angina is not supported by the latest evidence. Several ongoing trials will provide new insights into physiology-guided revascularisation in TAVI recipients. The role of the heart team remains essential in this complex patient group, and if revascularisation is being considered careful evaluation of clinical, anatomical and procedural factors is essential for individualised decision-making.

  • Aortic Valve Stenosis
  • Coronary Artery Disease
  • Transcatheter Aortic Valve Replacement
  • Heart Valve Prosthesis Implantation
  • Percutaneous Coronary Intervention

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Footnotes

  • Contributors The manuscript was written for submission by VA. The final manuscript was reviewed prior to submission by TP and SRR.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

  • Author note References which include a * are considered to be key references.