Endovascular treatment of aortic valve stenosis in combination with coronary artery disease: a systematic review

Objective: To evaluate and compare the efficacy and safety of simultaneous and staged techniques of percutaneous coronary interventions (PCI) and transcatheter aortic valve implantation (TAVI). Methods: The search for sources was carried out in the PubMed, Google Scholar and Cochrane Library databases using keywords. We selected the most cited studies on strategies for endovascular treatment of patients with coronary artery disease and aortic stenosis with the focus on simultaneous and staged techniques of PCI and TAVI. Most attention has been paid to indicators of survival, complications and other study endpoints. The significance of the order of the interventions on patient outcomes was assessed. Results: Searching with keywords in the selected databases revealed 1,527 original sources and 60 of them were taken into the review. The selected sources included prospective and retrospective studies as well as the latest guidelines of professional societies on cardiovascular diseases, statistics of surgical interventions and morbidity, and basic researches. In approximately 70% of cases, a staged technique was used with initial putting into practice of PCI followed by TAVI. Most studies comparing selected techniques did not reveal a significant difference in endpoints; at the hospital period their frequency was usually within 3%, and at the long-term period they reached 30%. Nevertheless, a detailed analysis of the frequency of certain control points revealed contradictions in a number of studies. Conclusion: Despite intensive research into the effects of simultaneous and staged techniques of PCI and TAVI, the point of which approach is better remains disputable. The order of interventions is not reflected in current guidelines, majority of studies are retrospective, and their conclusions are ambiguous. Additional prospective studies are needed to determine the categories of patients who will benefit most from a particular order of PCI and TAVI.