Management of Coronary Artery Disease in the Setting of Transcatheter Aortic Valve Replacement

Aortic stenosis and coronary artery disease (CAD) frequently co-exist as they share a common pathophysiology and risk factors. Due to lack of randomised controlled trials (RCTs) and exclusion of significant CAD in transcatheter aortic valve replacement (TAVR) trials, the optimal method of revascularisation of CAD in patients undergoing TAVR, remains unknown. Observational studies and meta-analyses have shown varied results in outcomes for patients with CAD undergoing TAVR and no significant difference in post-TAVR outcomes in patients who underwent revascularisation either prior to or during TAVR, versus those who did not. However, some observational studies have shown that patients with lower residual SYNTAX score (rSS) post-revascularisation have better outcomes post-TAVR compared to those with higher rSS. RCTs are needed to clearly understand whether revascularisation is beneficial in these patients. Until then, management of CAD in patients undergoing TAVR must be individualised based on discussion with the heart team.