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2017 Update Incorporated - Valvular Heart Disease

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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

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