When to perform percutaneous coronary interventions in TAVI patients? Recent advances

Coronary artery disease (CAD) is prevalent in approximately 50% of patients with severe aortic\r\nvalve stenosis undergoing transcatheter aortic valve implantation (TAVI). The impact of CAD\r\non TAVI outcomes and optimal management strategies remains unclear.\r\nThis manuscript reviews the latest evidence on assessing and determining the timing for\r\ntreating CAD in TAVI patients to optimize clinical outcomes and resource utilization.\r\nWe discuss the current methods for CAD diagnosis, including invasive coronary angiography\r\n(ICA), coronary computed tomography angiography, and the role of functional assessment\r\nindices like fractional flow reserve and instantaneous wave-free ratio in guiding\r\nrevascularization decisions. While ICA remains the standard for determining CAD severity in\r\nTAVI candidates, coronary computed tomography angiography has shown potential in\r\nreducing unnecessary ICA procedures. When indicated, fractional flow reserve seems more\r\nreliable than instantaneous wave-free ratio in aortic valve stenosis patients, particularly when evaluated post-TAVI. Recent data suggest that percutaneous coronary intervention post-TAVI\r\nmay be associated with improved outcomes compared to pre-TAVI interventions.\r\nConcluding, the optimal management of CAD in TAVI patients is still under investigation.\r\nCurrent evidence supports a tailored approach, considering both pre- and post-TAVI\r\npercutaneous coronary intervention strategies based on individual patient characteristics and\r\nprocedural complexities. Further randomized trials are needed to establish definitive\r\nguidelines.