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经导管主动脉瓣置换术患者的冠状动脉疾病与血运重建

Coronary Artery Disease and Revascularization in Patients Undergoing Transcatheter Aortic Valve Replacement.

作者信息

Garg Aakash, Ilyas Suleman, Cryer Michael, Abbott J Dawn

机构信息

Division of Cardiology, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA.

Division of Cardiology, Tucson Medical Center, Tucson, AZ 85712, USA.

出版信息

Rev Cardiovasc Med. 2022 Aug 22;23(9):290. doi: 10.31083/j.rcm2309290. eCollection 2022 Sep.

Abstract

Coronary artery disease (CAD) and aortic stenosis share similar risk factors and underlying pathophysiology. Up to half of the patient population undergoing work-up for aortic valve replacement have underlying CAD, which can affect outcomes in patients with more severe disease. As the indications for transcatheter aortic valve replacement (TAVR) have expanded to intermediate and now low risk patients, the optimal management of CAD in this patient population still needs to be determined. This includes both pre-TAVR evaluation for CAD as well as indications for revascularization in patients undergoing TAVR. There is also limited data on coronary interventions after TAVR, including the incidence, feasibility and outcomes of patients undergoing percutaneous coronary intervention (PCI) after TAVR. This review provides an updated report of the current literature on CAD in TAVR patients, focusing on its prevalence, impact on outcomes, timing of revascularization and potential challenges with coronary interventions post-TAVR.

摘要

冠状动脉疾病(CAD)和主动脉瓣狭窄具有相似的危险因素和潜在病理生理学。在接受主动脉瓣置换术前检查的患者中,高达一半的人患有潜在的CAD,这可能会影响病情较重患者的治疗结果。随着经导管主动脉瓣置换术(TAVR)的适应症已扩展至中度以及现在的低风险患者,该患者群体中CAD的最佳管理仍有待确定。这包括TAVR术前对CAD的评估以及TAVR患者的血运重建适应症。关于TAVR术后冠状动脉介入治疗的数据也很有限,包括TAVR术后接受经皮冠状动脉介入治疗(PCI)患者的发生率、可行性和治疗结果。本综述提供了关于TAVR患者CAD的当前文献的最新报告,重点关注其患病率、对治疗结果的影响、血运重建的时机以及TAVR术后冠状动脉介入治疗的潜在挑战。

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