Invasive functional assessment of coronary lesions in TAVI candidates by using frac- tional flow reserve or instantaneous wave-free ratio is safe and feasible.13 15 Instantaneous wave- free ratio may be particularly attractive because it does not require the administration of a vaso- dilator and is less influenced by the effect of the stenotic aortic valve, although randomized clinical trials validating the utility of both are ongoing. 2. There are no RCTs to inform clinical practice on the benefits and timing of PCI in patients under- going TAVI. The decision to perform PCI is there- fore driven by myriad clinical factors (eg, presence of angina or ischemia, ability to take dual-anti- platelet therapy before TAVI) and anatomic fac- tors (eg, lesion location and complexity, technical feasibility) and should be individualized. Overall, nonrandomized studies suggest that PCI before TAVI is safe and feasible,1 even in patients with left main disease.2 Conceptually, pre-TAVI PCI also allows a safer procedure and circumvents future post-TAVI PCI, which can be occasionally challenging. Staged PCI before TAVI is a common strategy in clinical practice and is associated with lower contrast volume and renal failure than is the strategy of TAVI with concomitant PCI,1 although the timing of pre-TAVI PCI remains controversial. 3. Multiple RCTs have been conducted to define the optimal management of CAD in patients with- out VHD based on the SYNTAX score to define Figure 19. Management of CAD in patients undergoing valve interventions. Colors correspond to Table 2. *Including men age >40 years and postmenopausal women. AVR indicates aortic valve replacement; CAD, coronary artery disease; CABG, coronary artery bypass graft; CT, computed tomography; LV, left ventricular; MR, mitral regurgitation; PCI, percutaneous coronary intervention; SYNTAX, Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery; and TAVI, transcatheter aortic valve implantation. 