Combining Transcatheter Aortic Valve Replacement and Coronary Angiography/Percutaneous Coronary Intervention Procedures

About half of elderly patients with severe aortic stenosis exhibit some degree of obstructive coronary artery disease that is routinely addressed at the time of surgical aortic valve replacement (SAVR).1 Transcatheter aortic valve replacement (TAVR) has emerged as a valid alternative to SAVR for the treatment of intermediate to high surgical risk patients. More than half of TAVR candidates have a history of coronary artery disease (about one third with prior coronary artery bypass grafting [CABG]), and coronary angiography prior to the procedure has been established as a routine examination to depict the presence of obstructive coronary lesions.1 Severe coronary stenoses located at the proximal-mid segment of the main coronary arteries are usually treated by percutaneous coronary intervention (PCI) at the time of coronary angiography, and this occurs in ≈20% of TAVR candidates. The timing between coronary angiography/PCI and TAVR is highly variable (from days to several weeks) depending on centers’ preference and logistic aspects.1 Some studies including a limited number of patients have evaluated the possibility of performing coronary angiography/PCI at the time of TAVR.2–6 The reasons for such an approach (rather than staged procedures) could be (1) to improve the logistics and patient comfort, and reduce the costs associated with the pre-TAVR workup and (2) to optimize vascular access and possibly reduce vascular complications by avoiding multiple punctures of the same or different vascular accesses at different time points. Although combining coronary angiography (±PCI) and TAVR procedures appeared to be safe in most of these studies, some suggested an increased risk of periprocedural complications, such as myocardial infarction or acute kidney injury.2,6See Article by Barbanti et al In this issue of the journal, Barbanti et al7 reported the results of a large series of patients (n=604) who …