Faroux Laurent, Villecourt Aurélien, Metz Damien
Cardiology Department, Reims University Hospital, 51100 Reims, France.
J Clin Med. 2023 Nov 16;12(22):7126. doi: 10.3390/jcm12227126.
About half of the transcatheter aortic valve replacement (TAVR) recipients exhibit some degree of coronary artery disease (CAD), and controversial results have been reported regarding the impact of the presence and severity of CAD on clinical outcomes post-TAVR. In addition to coronary angiography, promising data has been recently reported on the use of both cardiac computed tomography angiography and the functional invasive assessment of coronary lesions whether by FFR or iFR in the work-up pre-TAVR. Despite mitigated available data, percutaneous revascularization of significant coronary lesions has been the routine strategy in TAVR candidates with CAD. Additionally, scarce data exists on the incidence, characteristics and management of coronary events post-TAVR, and increasing interest exists on the potential coronary access challenges in patients requiring coronary angiography/intervention post-TAVR. This review provides an updated overview of the knowledge of CAD in TAVR recipients, focusing on its prevalence, clinical impact, pre- and post-procedural evaluation and management.
约一半经导管主动脉瓣置换术(TAVR)接受者存在一定程度的冠状动脉疾病(CAD),关于CAD的存在及严重程度对TAVR术后临床结局的影响,已有一些存在争议的报道。除冠状动脉造影外,近期有关于在TAVR术前评估中使用心脏计算机断层扫描血管造影以及通过血流储备分数(FFR)或瞬时无波形比值(iFR)对冠状动脉病变进行功能侵入性评估的有前景的数据报道。尽管现有数据有限,但对有CAD的TAVR候选者,对显著冠状动脉病变进行经皮血管重建一直是常规策略。此外,关于TAVR术后冠状动脉事件的发生率、特征及管理的数据稀缺,且对于TAVR术后需要冠状动脉造影/干预的患者潜在的冠状动脉通路挑战,人们的兴趣日益增加。本综述提供了TAVR接受者CAD相关知识的最新概述,重点关注其患病率、临床影响、术前和术后评估及管理。