57
Figure 9. Evaluation and Management of CAD in
Patients Undergoing Valve Surgery
Coronary Evaluation Prior to
Valve Surgery
Functional
MR
• Men >40 y of
age
• Postmenopausal
women
• Other coronary
risk factors
• Symptoms of
angina
• Objective
evidence of
ischemia
• Descreased LV
systolic function
• Hisotry of CAD
Emergency valve
surgery (acute
valve regurgitation,
aortic root disease,
or IE)
Low or
intermediate
pretest
likelihood
CAD
High pretest
likelihood
CAD
Alternative
approach
Coronary CT
angiography
(IIa)
Abnormal
Normal
CAD with ≥70% diameter stenosis
of a major coronary artery or ≥50%
diameter left main stenosis
Coronary angiography
(I)
Valve
surgery
NO
YES
Valve surgery
with CABG or
PCI
(IIa)
Valve
surgery
Valve surgery
without coronary
angiography
(IIa)
Surgical Considerations
in Patients With CAD
