Key result
Post-TAVR coronary revascularization proves safe and feasible in patients without high-grade proximal coronary disease.
This review proposes that in TAVR patients without high-grade proximal coronary artery disease, post-TAVR revascularization is safe and feasible, and preoperative TAVR CT angiography can help guide timing.
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May support post-TAVR revascularization in select patients without high-grade proximal CAD; leaves open need for prospective trials.
Patients with concomitant severe aortic stenosis and significant coronary artery disease present a diagnostic and therapeutic challenge in clinical practice. There are no clear-cut guidelines as to the timing of revascularization in these patients who are referred for transcatheter aortic valve replacement (TAVR). This article aims to show that in patients without high-grade proximal coronary artery disease, revascularization after TAVR is safe, feasible, and practical. Additionally, the use of preoperative TAVR computed tomographic angiography might be used in both intermediate and high-risk patients rather than invasive coronary angiography to assess for significant proximal coronary artery disease to help guide the timing of revascularization.
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McHugh et al. (2026) conducted a review in Concomitant severe aortic stenosis and significant coronary artery disease referred for transcatheter aortic valve replacement (TAVR). Coronary artery revascularization after TAVR and preoperative TAVR computed tomographic angiography vs. Pre-TAVR revascularization and invasive coronary angiography was evaluated. Coronary revascularization after TAVR is described as safe, feasible, and practical in patients without high-grade proximal coronary artery disease (no quantitative statistics reported).
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