Purpose of Review

To summarize epidemiology, pathophysiology, prognostic relevance, and treatment options of coronary artery disease (CAD) when coupled with severe aortic stenosis (SAS). In regard to treatment options, we focused on the most recently adopted therapeutic approaches and on the future perspectives in light of the latest percutaneous and surgical technical improvements in the field of both CAD and SAS management.

Recent Findings

Nowadays, SAS is the most common valve disease requiring intervention, either surgical or percutaneous. On the other side, CAD is one of the leading causes of death in the developed countries. CAD and degenerative SAS share several predisposing factors and are often concurrently found in clinical practice. Despite in the last years the transcatheter aortic valve replacement (TAVR) has been deeply changing the therapeutic approach to SAS, the correct management of patients with concomitant CAD remains controversial due to limited and heterogeneous data in the literature.

Summary

Coronary revascularization is often performed in patients with concomitant CAD and SAS. Complete surgical approach is still the standard of care according to international guidelines. However, in light of the recent results of TAVR trials, the therapeutic approach is expected to change. To date, percutaneous coronary intervention performed before TAVR is safe and feasible even if the optimal timing for revascularization remains debated. Due to the great complexity of the patients affected by SAS and CAD and until unquestionable truths will come from large randomized trials, the role of the Heart Team in the decision-making process is of primary importance to guarantee the best tailored therapeutic strategy for the single patient.

中文翻译：

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变性严重的主动脉瓣狭窄和合并的冠状动脉疾病：“经导管革命”时代的变化是什么？

审查目的

总结冠状动脉疾病（CAD）合并严重主动脉瓣狭窄（SAS）的流行病学，病理生理学，预后相关性和治疗选择。关于治疗选择，我们根据CAD和SAS管理领域的最新经皮和手术技术改进，着眼于最新采用的治疗方法和未来前景。

最近的发现

如今，SAS是最常见的需要手术或经皮干预的瓣膜疾病。另一方面，CAD是发达国家的主要死亡原因之一。CAD和退化性SAS具有几个易患因素，并且在临床实践中经常同时发现。尽管在过去的几年中，经导管主动脉瓣置换术（TAVR）一直在深刻地改变SAS的治疗方法，但由于文献中的数据有限且种类繁多，因此伴有CAD的患者的正确治疗仍存在争议。

概要

伴有CAD和SAS的患者经常进行冠状动脉血运重建。根据国际准则，完整的手术方法仍然是护理的标准。但是，根据TAVR试验的最新结果，治疗方法有望发生变化。迄今为止，即使对于血运重建的最佳时机仍有争议，在TAVR之前进行的经皮冠状动脉介入治疗是安全可行的。由于受SAS和CAD影响的患者非常复杂，并且在大型随机试验中将出现毫无疑问的真相之前，心脏团队在决策过程中的作用对于确保针对单个患者的最佳定制治疗策略至关重要患者。