Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
J Am Coll Cardiol. 2019 Jul 23;74(3):362-372. doi: 10.1016/j.jacc.2019.06.012.
About one-half of transcatheter aortic valve replacement (TAVR) candidates have coronary artery disease (CAD), and controversial results have been reported regarding the effect of the presence and severity of CAD on clinical outcomes post-TAVR. In addition to coronary angiography, promising data has been recently reported on both the use of computed tomography angiography and the functional invasive assessment of coronary lesions in the work-up pre-TAVR. While waiting for the results of ongoing randomized trials, percutaneous revascularization of significant coronary lesions has been the routine strategy in TAVR candidates with CAD. Also, scarce data exists on the incidence, characteristics, and management of coronary events post-TAVR, and increasing interest exist on potential coronary access challenges in patients requiring coronary angiography/intervention post-TAVR. This review provides an updated overview of the current landscape of CAD in TAVR recipients, focusing on its prevalence, clinical impact, pre- and post-procedural evaluation and management, unresolved issues and future perspectives.
约一半的经导管主动脉瓣置换术（TAVR）患者存在冠状动脉疾病（CAD），CAD 的存在和严重程度对 TAVR 后临床结局的影响存在争议。除了冠状动脉造影术，最近还报道了在 TAVR 前评估中使用计算机断层血管造影术和冠状动脉病变的功能侵入性评估的有前途的数据。在等待正在进行的随机试验结果的同时，经皮血运重建术已成为 CAD 患者 TAVR 候选者的常规策略。此外，关于 TAVR 后冠状动脉事件的发生率、特征和处理方法的数据很少，并且对需要在 TAVR 后进行冠状动脉造影术/介入治疗的患者的潜在冠状动脉入路挑战存在越来越大的兴趣。本综述提供了 TAVR 受者 CAD 的最新概述，重点介绍了其患病率、临床影响、术前和术后评估和管理、未解决的问题和未来展望。
