The following are key points to remember from this state-of-the-art review on coronary artery disease (CAD) and transcatheter aortic valve replacement (TAVR):

1. Approximately one-half of TAVR candidates have CAD, and controversial results have been reported regarding the effect of the presence and severity of CAD on clinical outcomes post-TAVR.
2. In addition to coronary angiography, preliminary data have been recently reported on both the use of computed tomography angiography and the functional invasive assessment of coronary lesions in the workup pre-TAVR.
3. Of note, the impact of CAD in TAVR recipients remains controversial, and no definite data exist on the most appropriate revascularization strategy in these patients.
4. Percutaneous revascularization of significant coronary lesions has been the routine strategy in TAVR candidates with CAD.
5. Ongoing randomized trials should determine the efficacy of this strategy (vs. no revascularization) in the coming years.
6. Furthermore, the most appropriate timing of percutaneous coronary intervention (PCI) pre-TAVR remains undetermined, and the possibility of a combined procedure (PCI at the time of TAVR) merits further evaluation, particularly in patients with no complex CAD or kidney dysfunction.
7. There are scarce data on the incidence, characteristics, and management of coronary events post-TAVR, and increasing interest exists on potential coronary access challenges in patients requiring coronary angiography/intervention post-TAVR.
8. The fact that many patients with a coronary syndrome post-TAVR are treated in centers with no TAVR experience further highlights the importance of establishing clear recommendations regarding selective coronary angiography and PCI in these cases.
9. Additional data are urgently needed regarding the coronary access (feasibility and failure rate) across different transcatheter valve types.
10. The recent publication of two randomized trials with positive results for TAVR in a low-risk aortic stenosis population has provided definite evidence for extending this treatment toward younger and lower-risk patients, and it will be important to prioritize studies to better delineate management of CAD pre- and post-procedure for those undergoing TAVR.

Clinical Topics: Cardiac Surgery, Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Valvular Heart Disease, Atherosclerotic Disease (CAD/PAD), Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and VHD, Interventions and Coronary Artery Disease, Interventions and Imaging, Interventions and Structural Heart Disease, Angiography, Nuclear Imaging

Keywords: Aortic Valve Stenosis, Coronary Angiography, Coronary Artery Disease, Heart Valve Diseases, Myocardial Ischemia, Myocardial Revascularization, Percutaneous Coronary Intervention, Risk, Secondary Prevention, Transcatheter Aortic Valve Replacement

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