Coronary Revascularization in the Era of Transcatheter Aortic Valve Replacement: Treat the Patient, Manage the Disease

Coronary artery disease continues to be the greatest cause of global mortality. The prevalence of coronary artery disease in patients with severe aortic stenosis varies widely, from 80% in extreme high-risk trials to only 15% in more recent low risk trials [1-3]. Given the higher risk of mortality in patients with coronary artery disease, guidelines suggest that revascularization with coronary artery bypass grafting (CABG) be considered in patients undergoing surgical aortic valve replacement [4]. Therefore, early trials of transcatheter aortic valve replacement (TAVR) required coronary angiography prior to consideration of TAVR. Percutaneous coronary intervention (PCI) of proximal and mid lesions in major coronary arteries was recommended during the first decade of TAVR. Yet there have been conflicting data with regard to outcomes of patients undergoing PCI prior to TAVR.