naa a22 4500 510728049 CHVBK 20180411082942.0 cr unu---uuuuu 180411e20131201xx s 000 0 eng 10.1007/s11748-013-0242-4 doi (NATIONALLICENCE)springer-10.1007/s11748-013-0242-4 Kobayashi Junjiro Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, 565-8565, Suita, Osaka, Japan aut Changing strategy for aortic stenosis with coronary artery disease by transcatheter aortic valve implantation [Elektronische Daten] [Junjiro Kobayashi] Coronary artery disease (CAD) is combined with aortic stenosis (AS) in 40-50% of patients with typical angina. Recently, transcatheter aortic valve implantation (TAVI) has changed the guideline for AS in patients with high comorbidity. At the same time more than 60% of isolated CABG has been performed without cardiopulmonary bypass in Japan. CABG is recommended and should be considered in patients with primary indication for AVR and luminal stenosis >70% in major coronary arteries and the left internal thoracic artery (LITA) by guidelines. AVR is indicated for severe AS undergoing CABG. It is generally accepted to perform AVR for moderate AS at the time of CABG by valve guidelines. However, prophylactic AVR for moderate AS associated with CABG may increase the early operative risk and expose the patients to postoperative long-term valve related complications. AVR after previous CABG poses potential risk for mortality and morbidity. The presence of patent ITA is a significant risk of its injury and difficulty of myocardial protection during aortic cross-clamping. Therefore, at present, for severe AS previous CABG with patent ITA should be one of the definite indications of TAVI. Rationale of TAVI in patients with severe AS and CAD has not been clearly delineated. The safety of TAVI irrespective of the extent and anatomy of CAD is still controversial. PCI is not appropriate before TAVI in high-risk patients with CAD. In the near future hybrid TAVI will be realistic considering least operative mortality and morbidity in high-risk patients. The Japanese Association for Thoracic Surgery, 2013 Cardiopulmonary bypass nationallicence Valves nationallicence Heart disease nationallicence Surgery nationallicence Coronary artery nationallicence General Thoracic and Cardiovascular Surgery Springer Japan 61/12(2013-12-01), 663-668 1863-6705 61:12<663 2013 61 11748 https://doi.org/10.1007/s11748-013-0242-4 text/html Onlinezugriff via DOI 1 review-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s11748-013-0242-4 text/html Onlinezugriff via DOI NATIONALLICENCE 100 1- Kobayashi Junjiro Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, 565-8565, Suita, Osaka, Japan aut NATIONALLICENCE 773 0- General Thoracic and Cardiovascular Surgery Springer Japan 61/12(2013-12-01), 663-668 1863-6705 61:12<663 2013 61 11748 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer