医学
冠状动脉疾病
狭窄
心脏病学
内科学
背景(考古学)
主动脉瓣置换术
瓣膜性心脏病
心绞痛
介入心脏病学
外科
心肌梗塞
生物
古生物学
作者
Vitaliy Androshchuk,Tiffany Patterson,Simon R Redwood
出处
期刊:Heart
[BMJ]
日期:2022-12-16
卷期号:109 (4): 322-329
被引量:3
标识
DOI:10.1136/heartjnl-2022-321605
摘要
Aortic stenosis (AS) is the most common valvular heart disorder in the elderly population. As a result of the shared pathophysiological processes, AS frequently coexists with coronary artery disease (CAD). These patients have traditionally been managed through surgical aortic valve replacement (SAVR) and coronary artery bypass grafting. However, increasing body of evidence supports transcatheter aortic valve implantation (TAVI) as an alternative treatment for severe AS across the spectrum of operative risk. This has created the potential for treating AS and concurrent CAD completely percutaneously. In this review we consider the evidence guiding the optimal management of patients with severe AS and CAD. While invasive coronary angiography plays a central role in detecting CAD in patients with AS undergoing surgery or TAVI, the benefits of complementary functional assessment of coronary stenosis in the context of AS have not been fully established. Although the indications for revascularisation of significant proximal CAD in SAVR patients have not recently changed, routine revascularisation of all significant CAD before TAVI in patients with minimal angina is not supported by the latest evidence. Several ongoing trials will provide new insights into physiology-guided revascularisation in TAVI recipients. The role of the heart team remains essential in this complex patient group, and if revascularisation is being considered careful evaluation of clinical, anatomical and procedural factors is essential for individualised decision-making.
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