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Degenerative Severe Aortic Stenosis and Concomitant Coronary Artery Disease: What Is Changing in the Era of the “Transcatheter Revolution”?

  • Evidence-Based Medicine, Clinical Trials and Their Interpretations​ (L. Roever, Section Editor)
  • Published:
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Abstract

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.

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Author notes

  1. Martino Pepe and Claudio Larosa contributed equally to this work.

Authors and Affiliations

  1. Division of Cardiology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy

    Martino Pepe, Palma Luisa Nestola & Stefano Favale

  2. Division of Cardiology, Lorenzo Bonomo Hospital, Andria, BT, Italy

    Claudio Larosa

  3. Division of Cardiology, Vittorio Emanuele II Hospital, Bisceglie, BT, Italy

    Isabella Rosa

  4. Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy

    Giuseppe Biondi-Zoccai

  5. Mediterranea Cardiocentro, Naples, Italy

    Giuseppe Biondi-Zoccai

  6. Chest Pain Unit, Cardiology Emergency, University of Bari, Bari, Italy

    Ottavio Di Cillo

  7. Division of Heart Surgery, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy

    Alessandro Santo Bortone

  8. Invasive Cardiology Unit, “Pineta Grande” Hospital, Castel Volturno, Caserta, Italy

    Arturo Giordano

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  1. Martino Pepe
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Pepe, M., Larosa, C., Rosa, I. et al. Degenerative Severe Aortic Stenosis and Concomitant Coronary Artery Disease: What Is Changing in the Era of the “Transcatheter Revolution”?. Curr Atheroscler Rep 22, 17 (2020). https://doi.org/10.1007/s11883-020-0835-1

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