Tavi Yapılacak Hastada Revaskülarizasyon Stratejisi ve Zamanlaması
Özet
Ciddi aort darlığı, özellikle ileri yaşta artan prevalansı nedeniyle önemli bir kardiyovasküler sorun olup, transkateter aort kapak implantasyonu (TAVI) günümüzde farklı risk gruplarında standart tedavi seçeneği haline gelmiştir. TAVI adaylarının %40–75’inde eşlik eden koroner arter hastalığı (KAH) bulunur ve bu durum tanı, tedavi ve prognozu karmaşıklaştırır. Tanıda koroner anjiyografi altın standarttır; koroner bilgisayarlı tomografi ve fonksiyonel testler tamamlayıcıdır. Revaskülarizasyon stratejisi bireyselleştirilmeli; lezyonun özelliklerine göre TAVI öncesi, eş zamanlı veya sonrası perkütan koroner girişim (PKG) tercih edilmelidir. Antitrombotik tedavi yaklaşımı, eşlik eden PKG ve antikoagülasyon ihtiyacına göre planlanmalıdır. Kompleks KAH varlığında cerrahi aort kapak replasmanı (AVR) + koroner arter bypass greftleme(CABG) uzun dönem sonuçları iyileştirirken, yüksek riskli hastalarda hibrit stratejiler alternatif olabilir. Multidisipliner yaklaşım, optimal tedavi ve uzun dönem prognoz için esastır.
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