Advertisement
Canadian Journal of Cardiology

Coronary Revascularization in Patients Undergoing Transcatheter Aortic Valve Replacement

Published:March 28, 2017DOI:https://doi.org/10.1016/j.cjca.2017.03.016

      Abstract

      Concomitant coronary artery disease (CAD) is highly prevalent among patients with severe aortic stenosis (AS). Historically, surgical aortic valve replacement with coronary artery bypass grafting was the only treatment option for patients with severe AS and significant CAD. The rapid expansion of transcatheter aortic valve replacement has led to significant paradigm shifts in the treatment of severe AS and has raised new questions regarding the optimal management of CAD in these patients. We review the evidence regarding management of concomitant CAD in severe AS patients, specifically focusing on issues surrounding transcatheter aortic valve replacement. In the absence of robust evidence supporting specific treatment strategies, decisions regarding coronary revascularization in severe AS should be individualized and made within the context of a multidisciplinary heart team.

      Résumé

      La coronaropathie concomitante est très fréquente chez les patients atteints de sténose aortique (SA) sévère. Historiquement, le remplacement valvulaire aortique chirurgicale avec pontage aortocoronarien était la seule option thérapeutique chez les patients atteints de SA sévère et de coronaropathie significative. La diffusion rapide du remplacement valvulaire aortique percutanée a entraîné d’importants changements de paradigme dans le traitement de la SA sévère et soulevé de nouvelles questions au sujet de la prise en charge optimale de la coronaropathie chez ces patients. Nous passons en revue les données probantes sur la prise en charge de la coronaropathie concomitante chez les patients atteints de SA sévère en nous concentrant particulièrement sur les questions touchant le remplacement valvulaire aortique percutanée. En l’absence de solides données probantes plaidant en faveur de stratégies thérapeutiques précises, les décisions relatives à la revascularisation coronarienne dans les cas de SA sévère doivent être individualisées et prises au sein d’une équipe multidisciplinaire en santé cardiaque.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Canadian Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Rapp A.H.
        • Hillis L.D.
        • Lange R.A.
        • Cigarroa J.E.
        Prevalence of coronary artery disease in patients with aortic stenosis with and without angina pectoris.
        Am J Cardiol. 2001; 87: 1216-1217
        • Vandeplas A.
        • Willems J.L.
        • Piessens J.
        • De Geest H.
        Frequency of angina pectoris and coronary artery disease in severe isolated valvular aortic stenosis.
        Am J Cardiol. 1988; 62: 117-120
        • Iung B.
        Interface between valve disease and ischaemic heart disease.
        Heart. 2000; 84: 347-352
        • Beach J.M.
        • Mihaljevic T.
        • Svensson L.G.
        • et al.
        Coronary artery disease and outcomes of aortic valve replacement for severe aortic stenosis.
        J Am Coll Cardiol. 2013; 61: 837-848
        • Nishimura R.A.
        • Otto C.M.
        • Bonow R.O.
        • et al.
        2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.
        J Am Coll Cardiol. 2014; 63: e57-e185
        • Makkar R.
        • Fontana G.
        • Jilaihawi H.
        • et al.
        Transcatheter aortic-valve replacement for inoperable severe aortic stenosis.
        N Engl J Med. 2012; 366: 1696-1704
        • Kodali S.K.
        • Williams M.R.
        • Smith C.R.
        • et al.
        Two-year outcomes after transcatheter or surgical aortic-valve replacement.
        N Engl J Med. 2012; 366: 1686-1695
        • Kodali S.
        • Thourani V.H.
        • White J.
        • et al.
        Early clinical and echocardiographic outcomes after SAPIEN 3 transcatheter aortic valve replacement in inoperable, high-risk and intermediate-risk patients with aortic stenosis.
        Eur Heart J. 2016; 37: 2252-2262
        • Stewart B.F.
        • Siscovick D.
        • Lind B.K.
        • et al.
        Clinical factors associated with calcific aortic valve disease. Cardiovascular Health Study.
        J Am Coll Cardiol. 1997; 29: 630-634
        • Leon M.B.
        • Smith C.R.
        • Mack M.
        • et al.
        Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery.
        N Engl J Med. 2010; 363: 1597-1607
        • Smith C.R.
        • Leon M.B.
        • Mack M.J.
        • et al.
        Transcatheter versus surgical aortic-valve replacement in high-risk patients.
        N Engl J Med. 2011; 364: 2187-2198
        • Gilard M.
        • Eltchaninoff H.
        • Iung B.
        • et al.
        Registry of transcatheter aortic-valve implantation in high-risk patients.
        N Engl J Med. 2012; 366: 1705-1715
        • Thomas M.
        • Schymik G.
        • Walther T.
        • et al.
        One-year outcomes of cohort 1 in the Edwards SAPIEN Aortic Bioprosthesis European Outcome (SOURCE) registry: the European registry of transcatheter aortic valve implantation using the Edwards SAPIEN valve.
        Circulation. 2011; 124: 425-433
        • Moat N.E.
        • Ludman P.
        • de Belder M.A.
        • et al.
        Long-term outcomes after transcatheter aortic valve implantation in high-risk patients with severe aortic stenosis: the U.K. TAVI (United Kingdom Transcatheter Aortic Valve Implantation) Registry.
        J Am Coll Cardiol. 2011; 58: 2130-2138
        • Tamburino C.
        • Capodanno D.
        • Ramondo A.
        • et al.
        Incidence and predictors of early and late mortality after transcatheter aortic valve implantation in 663 patients with severe aortic stenosis.
        Circulation. 2011; 123: 299-308
        • Rodés-Cabau J.
        • Webb J.G.
        • Cheung A.
        • et al.
        Transcatheter aortic valve implantation for the treatment of severe symptomatic aortic stenosis in patients at very high or prohibitive surgical risk: acute and late outcomes of the multicenter Canadian experience.
        J Am Coll Cardiol. 2010; 55: 1080-1090
        • Walther T.
        • Kasimir M.
        • Doss M.
        • et al.
        One-year interim follow-up results of the TRAVERCE trial: the initial feasibility study for trans-apical aortic-valve implantation.
        Eur J Cardiothorac Surg. 2011; 39: 532-537
        • Dewey T.M.
        • Brown D.L.
        • Herbert M.A.
        • et al.
        Effect of concomitant coronary artery disease on procedural and late outcomes of transcatheter aortic valve implantation.
        Ann Thorac Surg. 2010; 89: 758-767
        • Abdel-Wahab M.
        • Zahn R.
        • Horack M.
        • et al.
        Transcatheter aortic valve implantation in patients with and without concomitant coronary artery disease: comparison of characteristics and early outcome in the German multicenter TAVI registry.
        Clin Res Cardiol. 2012; 101: 973-981
        • Stefanini G.G.
        • Stortecky S.
        • Cao D.
        • et al.
        Coronary artery disease severity and aortic stenosis: clinical outcomes according to SYNTAX score in patients undergoing transcatheter aortic valve implantation.
        Eur Heart J. 2014; 35: 2530-2540
        • Masson J.B.
        • Lee M.
        • Boone R.H.
        • et al.
        Impact of coronary artery disease on outcomes after transcatheter aortic valve implantation.
        Catheter Cardiovasc Interv. 2010; 76: 165-173
        • Gautier M.
        • Pepin M.
        • Himbert D.
        • et al.
        Impact of coronary artery disease on indications for transcatheter aortic valve implantation and on procedural outcomes.
        EuroIntervention. 2011; 7: 549-555
        • Ussia G.P.
        • Barbanti M.
        • Colombo A.
        • et al.
        Impact of coronary artery disease in elderly patients undergoing transcatheter aortic valve implantation: insight from the Italian CoreValve Registry.
        Int J Cardiol. 2013; 167: 943-950
        • D'Ascenzo F.
        • Conrotto F.
        • Giordana F.
        • et al.
        Mid-term prognostic value of coronary artery disease in patients undergoing transcatheter aortic valve implantation: a meta-analysis of adjusted observational results.
        Int J Cardiol. 2013; 168: 2528-2532
        • Goel S.S.
        • Agarwal S.
        • Tuzcu E.M.
        • et al.
        Percutaneous coronary intervention in patients with severe aortic stenosis: implications for transcatheter aortic valve replacement.
        Circulation. 2012; 125: 1005-1013
        • Abdel-Wahab M.
        • Mostafa A.E.
        • Geist V.
        • et al.
        Comparison of outcomes in patients having isolated transcatheter aortic valve implantation versus combined with preprocedural percutaneous coronary intervention.
        Am J Cardiol. 2012; 109: 581-586
        • Gasparetto V.
        • Fraccaro C.
        • Tarantini G.
        • et al.
        Safety and effectiveness of a selective strategy for coronary artery revascularization before transcatheter aortic valve implantation.
        Catheter Cardiovasc Interv. 2012; 81: 376-383
        • Wenaweser P.
        • Pilgrim T.
        • Guerios E.
        • et al.
        Impact of coronary artery disease and percutaneous coronary intervention on outcomes in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation.
        EuroIntervention. 2011; 7: 541-548
        • Wendt D.
        • Kahlert P.
        • Lenze T.
        • et al.
        Management of high-risk patients with aortic stenosis and coronary artery disease.
        Ann Thorac Surg. 2013; 95: 599-605
        • Abramowitz Y.
        • Banai S.
        • Katz G.
        • et al.
        Comparison of early and late outcomes of TAVI alone compared to TAVI plus PCI in aortic stenosis patients with and without coronary artery disease.
        Catheter Cardiovasc Interv. 2013; 83: 649-654
        • Snow T.M.
        • Ludman P.
        • Banya W.
        • et al.
        Management of concomitant coronary artery disease in patients undergoing transcatheter aortic valve implantation: the United Kingdom TAVI Registry.
        Int J Cardiol. 2015; 199: 253-260
        • Mancio J.
        • Fontes-Carvalho R.
        • Oliveira M.
        • et al.
        Coronary artery disease and symptomatic severe aortic valve stenosis: clinical outcomes after transcatheter aortic valve implantation.
        Front Cardiovasc Med. 2015; 2: 1-7
        • Griese D.P.
        • Reents W.
        • Tóth A.
        • et al.
        Concomitant coronary intervention is associated with poorer early and late clinical outcomes in selected elderly patients receiving transcatheter aortic valve implantation.
        Eur J Cardiothorac Surg. 2014; 46: e1-e7
        • Singh V.
        • Rodriguez A.P.
        • Thakkar B.
        • et al.
        Comparison of outcomes of transcatheter aortic valve replacement plus percutaneous coronary intervention versus transcatheter aortic valve replacement alone in the United States.
        Am J Cardiol. 2016; 118: 1698-1704
        • Khawaja M.Z.
        • Wang D.
        • Pocock S.
        • Redwood S.R.
        • Thomas M.R.
        The percutaneous coronary intervention prior to transcatheter aortic valve implantation (ACTIVATION) trial: study protocol for a randomized controlled trial.
        Trials. 2014; 15: 300-308
        • Paradis J.M.
        • Fried J.
        • Nazif T.
        • et al.
        Aortic stenosis and coronary artery disease: what do we know? What don't we know? A comprehensive review of the literature with proposed treatment algorithms.
        Eur Heart J. 2014; 35: 2069-2082
        • Andreini D.
        • Pontone G.
        • Mushtaq S.
        • et al.
        Diagnostic accuracy of multidetector computed tomography coronary angiography in 325 consecutive patients referred for transcatheter aortic valve replacement.
        Am Heart J. 2014; 168: 332-339
        • Leon M.B.
        • Smith C.R.
        • Mack M.J.
        • et al.
        Transcatheter or surgical aortic-valve replacement in intermediate-risk patients.
        N Engl J Med. 2016; 374: 1609-1620
        • Jaffe R.
        • Finkelstein A.
        • Lewis B.S.
        • et al.
        Stenting of the unprotected left main coronary artery in patients with severe aortic stenosis prior to percutaneous valve interventions.
        Cardiovasc Revasc Med. 2012; 13: 90-94
        • Chakravarty T.
        • Sharma R.
        • Abramowitz Y.
        • et al.
        Outcomes in patients with transcatheter aortic valve replacement and left main stenting.
        J Am Coll Cardiol. 2016; 67: 951-960
        • van Rosendael P.J.
        • van der Kley F.
        • Kamperidis V.
        • et al.
        Timing of staged percutaneous coronary intervention before transcatheter aortic valve implantation.
        Am J Cardiol. 2015; 115: 1726-1732
        • Conradi L.
        • Seiffert M.
        • Franzen O.
        • et al.
        First experience with transcatheter aortic valve implantation and concomitant percutaneous coronary intervention.
        Clin Res Cardiol. 2011; 100: 311-316
        • Pasic M.
        • Dreysse S.
        • Unbehaun A.
        • et al.
        Combined elective percutaneous coronary intervention and transapical transcatheter aortic valve implantation.
        Interact Cardiovasc Thorac Surg. 2012; 14: 463-468
        • Blumenstein J.
        • Kim W.K.
        • Liebetrau C.
        • et al.
        Challenges of coronary angiography and intervention in patients previously treated by TAVI.
        Clin Res Cardiol. 2015; 104: 632-639
        • Allali A.
        • El-Mawardy M.
        • Schwarz B.
        • et al.
        Incidence, feasibility and outcome of percutaneous coronary intervention after transcatheter aortic valve implantation with a self-expanding prosthesis.
        Cardiovasc Revasc Med. 2016; 17: 391-398
        • Freixa X.
        • Chan J.
        • Bonan R.
        • et al.
        Impact of coronary artery disease on left ventricular ejection fraction recovery following transcatheter aortic valve implantation.
        Catheter Cardiovasc Interv. 2014; 85: 450-458
        • Van Mieghem N.M.
        • van der Boon R.M.
        • Faqiri E.
        • et al.
        Complete revascularization is not a prerequisite for success in current transcatheter aortic valve implantation practice.
        JACC Cardiovasc Interv. 2013; 6: 867-875
        • Taha S.
        • Moretti C.
        • D'Ascenzo F.
        • et al.
        Impact of residual coronary artery disease on patients undergoing TAVI: a meta-analysis of adjusted observational studies.
        Int J Cardiol. 2015; 181: 77-80
        • Stähli B.E.
        • Maier W.
        • Corti R.
        • Lüscher T.F.
        • Altwegg L.A.
        Fractional flow reserve evaluation in patients considered for transfemoral transcatheter aortic valve implantation: a case series.
        Cardiology. 2012; 123: 234-239
        • Pesarini G.
        • Scarsini R.
        • Zivelonghi C.
        • et al.
        Functional assessment of coronary artery disease in patients undergoing transcatheter aortic valve implantation: influence of pressure overload on the evaluation of lesions severity.
        Circ Cardiovasc Interv. 2016; 9: e004088
        • Rajappan K.
        • Rimoldi O.E.
        • Dutka D.P.
        • et al.
        Mechanisms of coronary microcirculatory dysfunction in patients with aortic stenosis and angiographically normal coronary arteries.
        Circulation. 2002; 105: 470-476
        • Demirkol M.O.
        • Yaymacı B.
        • Debeş H.
        • Başaran Y.
        • Turan F.
        Dipyridamole myocardial perfusion tomography in patients with severe aortic stenosis.
        Cardiology. 2002; 97: 37-42
        • Baroni M.
        • Maffei S.
        • Terrazzi M.
        • Palmieri C.
        • Paoli F.
        Mechanisms of regional ischaemic changes during dipyridamole echocardiography in patients with severe aortic valve stenosis and normal coronary arteries.
        Heart. 1996; 76: 492-497
        • Samuels B.
        • Kiat H.
        • Friedman J.D.
        Adenosine pharmacologic stress myocardial perfusion tomographic imaging in patients with significant aortic stenosis. Diagnostic efficacy and comparison of clinical, hemodynamic and electrocardiographic variables with 100 age-matched control subjects.
        J Am Coll Cardiol. 1995; 25: 99-106
        • Danson E.
        • Hansen P.
        • Sen S.
        • et al.
        Assessment, treatment, and prognostic implications of CAD in patients undergoing TAVI.
        Nat Rev Cardiol. 2016; 13: 276-285